Title: High-Resolution Anorectal Manometry for Diagnosing Obstructed Defecation Syndrome
Associated with Moderate Rectocele Compared to Healthy Individuals
Version: 3 Date: 13 Jun 2023
Reviewer's report:
1- The title does not fit with the study design (HARM was not used in the diagnosis of rectocele),
instead, it will be more appropriate if the title was about the assessment of anorectal physiology
in rectocele patients compared to healthy subjects.
2- The authors mentioned the term "moderate rectocele" in the abstract (background paragraph).
How can they define moderate rectocele?
3- In the abstract (results paragraph), the term "randomly assigned" was used despite the study's
retrospective nature.
4- The term "prognosis" was used multiple times in the manuscript in a confusing way. What is
meant by "prognosis"? Do the authors mean “progress” instead?
5- In the introduction: rectocele may be defined as herniation of the rectal wall through the
rectovaginal septum, but it cannot be described as a hernia or a mass.
6- On page (4), in the 2nd paragraph, sentences starting from “few studies ..." until the end of
the paragraph have no reference.
7- On the same page (4), the 4th paragraph is almost the same as the 3rd one.
8- The construction of the term "healthy subjects in women" is strange and requires modification.
9- The side heading (1.2) should refer to healthy subjects or volunteers.
10- In the "patient inclusion criteria" paragraph, why the authors included pathologies other
than rectocele? This action will result in a loss of direct relation between the results and the
rectocele as the other pathologies will interfere with these results. in this case, subgroup analysis
is mandatory.
11- In the "patient exclusion criteria" paragraph, I am not familiar with the term "fecalography".
Also, the meaning of the word "incompatibility" is not fully comprehended.
12- On page (7), in the 2nd paragraph, a reference to this information is required.
13- In the same paragraph, what is the reference value to the defecation index?
14- In the results section: again, the inclusion of cases of rectocele associated with other
pathologies will interfere with the results.
15- Under the side heading 2.2.2: it is important to clearly describe the degree of correlation.
(r=-0.28) can be described as weak, while (r=0.40) can be described as moderate).
16- In the "discussion" sector, page 10, in the first paragraph, after mentioning the results of
previous, what are the similarities and the differences between the results of your study and
previous studies and how can you explain them?
17- In the 2nd paragraph, I could not fully comprehend the sentence starting with "as a result,
the sensitivity of the RAIR ....".
18- Generally, it was important to assess ODS symptoms in patients using a valid score and to
test the correlation between this score and the manometry results in the patient group.
Title: High-Resolution Anorectal Manometry for Diagnosing Obstructed Defecation Syndrome
Associated with Moderate Rectocele Compared to Healthy Individuals
Version: 3 Date: 13 Jun 2023
Reviewer's report:
1- The title does not fit with the study design (HARM was not used in the diagnosis of rectocele),
instead, it will be more appropriate if the title was about the assessment of anorectal physiology
in rectocele patients compared to healthy subjects.
2- The authors mentioned the term "moderate rectocele" in the abstract (background paragraph).
How can they define moderate rectocele?
3- In the abstract (results paragraph), the term "randomly assigned" was used despite the study's
retrospective nature.
4- The term "prognosis" was used multiple times in the manuscript in a confusing way. What is
meant by "prognosis"? Do the authors mean “progress” instead?
5- In the introduction: rectocele may be defined as herniation of the rectal wall through the
rectovaginal septum, but it cannot be described as a hernia or a mass.
6- On page (4), in the 2nd paragraph, sentences starting from “few studies ..." until the end of
the paragraph have no reference.
7- On the same page (4), the 4th paragraph is almost the same as the 3rd one.
8- The construction of the term "healthy subjects in women" is strange and requires modification.
9- The side heading (1.2) should refer to healthy subjects or volunteers.
10- In the "patient inclusion criteria" paragraph, why the authors included pathologies other
than rectocele? This action will result in a loss of direct relation between the results and the
rectocele as the other pathologies will interfere with these results. in this case, subgroup analysis
is mandatory.
11- In the "patient exclusion criteria" paragraph, I am not familiar with the term "fecalography".
Also, the meaning of the word "incompatibility" is not fully comprehended.
12- On page (7), in the 2nd paragraph, a reference to this information is required.
13- In the same paragraph, what is the reference value to the defecation index?
14- In the results section: again, the inclusion of cases of rectocele associated with other
pathologies will interfere with the results.
15- Under the side heading 2.2.2: it is important to clearly describe the degree of correlation.
(r=-0.28) can be described as weak, while (r=0.40) can be described as moderate).
16- In the "discussion" sector, page 10, in the first paragraph, after mentioning the results of
previous, what are the similarities and the differences between the results of your study and
previous studies and how can you explain them?
17- In the 2nd paragraph, I could not fully comprehend the sentence starting with "as a result,
the sensitivity of the RAIR ....".
18- Generally, it was important to assess ODS symptoms in patients using a valid score and to
test the correlation between this score and the manometry results in the patient group.
Please review this paper.
user
Title: High-Resolution Anorectal Manometry for Diagnosing Obstructed Defecation Syndrome
Associated with Moderate Rectocele Compared to Healthy Individuals
Version: 3 Date: 13 Jun 2023
Reviewer's report:
1- The title does not fit with the study design (HARM was not used in the diagnosis of rectocele),
instead, it will be more appropriate if the title was about the assessment of anorectal physiology
in rectocele patients compared to healthy subjects.
2- The authors mentioned the term "moderate rectocele" in the abstract (background paragraph).
How can they define moderate rectocele?
3- In the abstract (results paragraph), the term "randomly assigned" was used despite the study's
retrospective nature.
4- The term "prognosis" was used multiple times in the manuscript in a confusing way. What is
meant by "prognosis"? Do the authors mean “progress” instead?
5- In the introduction: rectocele may be defined as herniation of the rectal wall through the
rectovaginal septum, but it cannot be described as a hernia or a mass.
6- On page (4), in the 2nd paragraph, sentences starting from “few studies ..." until the end of
the paragraph have no reference.
7- On the same page (4), the 4th paragraph is almost the same as the 3rd one.
8- The construction of the term "healthy subjects in women" is strange and requires modification.
9- The side heading (1.2) should refer to healthy subjects or volunteers.
10- In the "patient inclusion criteria" paragraph, why the authors included pathologies other
than rectocele? This action will result in a loss of direct relation between the results and the
rectocele as the other pathologies will interfere with these results. in this case, subgroup analysis
is mandatory.
11- In the "patient exclusion criteria" paragraph, I am not familiar with the term "fecalography".
Also, the meaning of the word "incompatibility" is not fully comprehended.
12- On page (7), in the 2nd paragraph, a reference to this information is required.
13- In the same paragraph, what is the reference value to the defecation index?
14- In the results section: again, the inclusion of cases of rectocele associated with other
pathologies will interfere with the results.
15- Under the side heading 2.2.2: it is important to clearly describe the degree of correlation.
(r=-0.28) can be described as weak, while (r=0.40) can be described as moderate).
16- In the "discussion" sector, page 10, in the first paragraph, after mentioning the results of
previous, what are the similarities and the differences between the results of your study and
previous studies and how can you explain them?
17- In the 2nd paragraph, I could not fully comprehend the sentence starting with "as a result,
the sensitivity of the RAIR ....".
18- Generally, it was important to assess ODS symptoms in patients using a valid score and to
test the correlation between this score and the manometry results in the patient group.
assistant