Reviewer ’s report  
 
Title: Lesion distribution characteristics of deep infiltrating endometriosis with ovarian  
endometrioma: An observational clinical study  
 
Version: 0 Date: 20 Jan 2020  
 
Reviewer: Pedro Acién  
 
Reviewer's report:  
 
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This is an observational study on the dis tribution of DIE lesions in a large number of patients (n 
= 304) with OEM, and all operated by one of the authors (S. Yao). They observed these DIE 
lesions in up to 30 anatomical sites. However, they are cited: vagina, posterior fornix, vaginal 
rectum and rectovaginal pouch, as different seating sites for DIE implants and I cannot clarify 
these locations.  
 
The results show that there were more DIE lesions among women with unilateral OEM, 
especially intestinal (¿), which seems logical as the other OEM does no t prevent its display. 
There were no other significant differences between the OEM groups.  
 
But I also have some doubts:  
 
1. Why were cases with laparoscopic surgery converted to open surgery excluded?  
 
2. The correspondence of the location of the lesions tha t I mentioned before: rectum, vaginal 
rectum, rectovaginal pouch ?, should be clarified.  
 
3. The importance of the complete exeresis of all DIE lesions is strongly insisted, don't you think 
that, as Dmowski said many years ago, counting the number of endome triosis lesions is like 
counting the number of spots of disseminated lupus erythematosus to see its severity ?, do the 
recurrences correspond to the implants without a complete exeresis ?.  
 
4. How do you explain that DIE implants are so frequent in uterosac ral ligaments (80.6%), 
vaginal, posterior fornix ?, etc, the DYSPAREUNIA symptom is only present in 12.8% of 
patients? And chronic pelvic pain in 5.6% ?.  
 
 
 
Are the methods appropriate and well described?  
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Unable to assess  
 
Does the work include the necessary controls?  
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Unable to assess  
 
Are the conclusions drawn adequately supported  by the data shown?  
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Unable to assess  
 
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additional statistical review?  
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assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
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Needs some language cor rections before being published  
 
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