Title: Comparison of Anal Dilatation Versus No Dilatation with A Standardized Dilator in
Reducing Pain After Hemorrhoidectomy: A Randomized Control Trial
Version: 4 Date: 24 Mar 2022
Reviewer:  Mohamed El-said
Reviewer's report:
First I would like to thank the authors for this smart and to the point manuscript.
I have few comments:
1- The preoperative continence was not assessed. If all patients were continent preoperatively,
this should be mentioned.
2- The degree of the postoperative FI was not assessed. If all cases who developped FI sufferred
only from minor FI (to flatus and soiling), at least this crude information should be mentioned.
3- If the authors are aware of other studies examining the short term effect (during the first
postoperative week) of anorectal surgeries involving anal dilatation (e.g. TEM) on continence,
discussing the results of some of these studies will enrich the discussion section.
4- The authors argued that preoperative anal dilatation decreases the risk of postoperative
stricture and thus decreasing postoperative pain. I think that too much excision of the anoderm
and rectal mucosa is the factor responsible for anal stricture.
I think this should be omitted from the discussion. Also the sentence discussing the benifit
of preoperative versus postoperative anal dilatation in the prevention and management of anal
stricture.
5- There are many studies that showed that internal sphincterotomy (chemical and surgical)
decreased postoperative anal pain and increase FI when combined with haemorrhoidectomy.
I think the authors should mention some of these studies and compare these methods with
controlled anal dilatation.
Title: Comparison of Anal Dilatation Versus No Dilatation with A Standardized Dilator in
Reducing Pain After Hemorrhoidectomy: A Randomized Control Trial
Version: 4 Date: 24 Mar 2022
Reviewer:  Mohamed El-said
Reviewer's report:
First I would like to thank the authors for this smart and to the point manuscript.
I have few comments:
1- The preoperative continence was not assessed. If all patients were continent preoperatively,
this should be mentioned.
2- The degree of the postoperative FI was not assessed. If all cases who developped FI sufferred
only from minor FI (to flatus and soiling), at least this crude information should be mentioned.
3- If the authors are aware of other studies examining the short term effect (during the first
postoperative week) of anorectal surgeries involving anal dilatation (e.g. TEM) on continence,
discussing the results of some of these studies will enrich the discussion section.
4- The authors argued that preoperative anal dilatation decreases the risk of postoperative
stricture and thus decreasing postoperative pain. I think that too much excision of the anoderm
and rectal mucosa is the factor responsible for anal stricture.
I think this should be omitted from the discussion. Also the sentence discussing the benifit
of preoperative versus postoperative anal dilatation in the prevention and management of anal
stricture.
5- There are many studies that showed that internal sphincterotomy (chemical and surgical)
decreased postoperative anal pain and increase FI when combined with haemorrhoidectomy.
I think the authors should mention some of these studies and compare these methods with
controlled anal dilatation.
Please review this paper.
user
Title: Comparison of Anal Dilatation Versus No Dilatation with A Standardized Dilator in
Reducing Pain After Hemorrhoidectomy: A Randomized Control Trial
Version: 4 Date: 24 Mar 2022
Reviewer:  Mohamed El-said
Reviewer's report:
First I would like to thank the authors for this smart and to the point manuscript.
I have few comments:
1- The preoperative continence was not assessed. If all patients were continent preoperatively,
this should be mentioned.
2- The degree of the postoperative FI was not assessed. If all cases who developped FI sufferred
only from minor FI (to flatus and soiling), at least this crude information should be mentioned.
3- If the authors are aware of other studies examining the short term effect (during the first
postoperative week) of anorectal surgeries involving anal dilatation (e.g. TEM) on continence,
discussing the results of some of these studies will enrich the discussion section.
4- The authors argued that preoperative anal dilatation decreases the risk of postoperative
stricture and thus decreasing postoperative pain. I think that too much excision of the anoderm
and rectal mucosa is the factor responsible for anal stricture.
I think this should be omitted from the discussion. Also the sentence discussing the benifit
of preoperative versus postoperative anal dilatation in the prevention and management of anal
stricture.
5- There are many studies that showed that internal sphincterotomy (chemical and surgical)
decreased postoperative anal pain and increase FI when combined with haemorrhoidectomy.
I think the authors should mention some of these studies and compare these methods with
controlled anal dilatation.
assistant