Review for 10.1186/s12876-024-03428-z (2024)

Title: IS CHEMODENERVATION WITH INCOBOTULINUMTOXINA AN
ALTERNATIVE TO INVASIVE CHRONIC ANAL FISSURE TREATMENTS?
Version: 3 Date: 17 Jul 2024
Reviewer's report:
Dear Authors,
the manuscript addresses a very interesting topic in the treatment of anal fissure associated with
high anal resting pressure using IncobotulinumtoxinA. Unfortunately, I think that it is needs
major revisions before any publication.
These are my suggestions:
- The title should be more explicit. The comparison is between botulinum toxin A and “ANAL”
sphincterotomy FOR THE TREATMENT OF ANAL FISSURE. I think you should change it
to better underline the goal of the study.
- Could the Introduction section be shortened? It seems too verbose for understanding the study.
- There are several surgical procedures for anal fissure (such as diathermocoagulation only), so
I think that you may put “i.e.” in the bracket before describing different surgical procedures.
- The Methods section needs several modifications/implementations. First of all, you should
specify IDIOPATHIC anal fissure because it is easier to understand.
- Moreover you could specify a MINIMUM follow up of 2 years (if it is the minimum follow up).
- Why do you use this dosage? Is there any other study on this kind of injection (both lateral
and posterior)? I think it is better to specify if it is your experience or there are other studies
on that aspect.
- Why do you use CI and not standard deviation in statistical analysis?
- There is a typo in the Result section, I think. Because you talk about 49 patients in the study
period, with a dropout of 19 patients. So the final number of patients should be 30, why do you
speak about 31 patients with a 2 year follow up? I flowchart could be useful.
- The treatment period started in September 2017 and finished in March 2022. However, you
underline that the study follow up is 2 years on June 1st 2023. It’s not 2 years! Can you explain?
A flowchart could help in better understanding.
- In the Results section you talk about a range of dose administered. Did you use different dosage
of botulinum toxin? Why? Was it standardized or not? You should explain in Methods section,
not only in the discussion (it could be a limitation of the study for the variability of the results).
- I have a doubt. In these 2 years the 30 or 31 patients were treated only with Botulinum toxin A?
No other cream? It is important to understand because I don’t know how many patients didn’t
use other creams. Could you underline this aspect?
- What is the mean follow up? It should be specified due to the range of treatment period.
- In the results section you talk about psychiatric disorders but they weren’t cited before. You
have to implement Methods section with patient’s data collection. What kind of data were
collected? What data were used for analysis? You have to do a table with any factors included
in the multivariate logistic analysis.
Given all these observations, I think that important changes are needed before proceeding with
the submission of this article. I am confident that, once the manuscript is modified, it could be
very interesting given the topics covered.