Title: Features of defecation dysfunction among patients with Hirschsprung disease in early
childhood
Version: 1 Date: 20 Oct 2024
Reviewer:  Alessio Pini Prato
Reviewer's report:
The paper is intriguing but I have some concerns
English form should be improved throughout the text.
Materials and Methods
1) there are no statements regarding the power analysis performed to determine the number of
patients and controls. Even if no power analysis was done, this should be mentioned in the text.
2) No mention is done regarding the age and sex matching of cases and controls and if present
or not this aspect should be addressed
Results
3) It  is unclear to me the meaning of the following sentence: “ In our study healthy control
children who were < 3 years of age had completed toilet training”
4) It is unclear the population of HSCR we are dealing with. the sentence stating: “There was
no difference between patients with RSHD and healthy control children with respect to the
male:female ratio, age, and weight at follow-up (all, P>0.05)”  suggest a distorced epidemiology
in this series of patients. In fact, I would expect a dramatic male prepondrance  with a statistically
significant differences of male to female ratio when comparing rectosigmoid HSCR and healty
population. Even comparing rectosigmoid, long and ultra long J HSCR, we should observe
a 4/5:1 ratio in classic form decreasing to a nearly 1:1 ratio in total colonic or extended
aganglionosis. This aspect should be considered for a better rephrasing of results section or to
develop an adequate discussion.
5) the statement “ These findings indicated that an inadequate ability to feel or report the urge
to defecate occurred in all HD types and was more severe in DTHDs and AIHDs, which may be
attributed to damage from intact sensations. The intact sensation lies on the anal tract or dentate
line and can be damaged during PT surgery by a lower level of dissection or anastomosis at the
dentate line [31]” is a clear discussion of the results and it should be moved to  the appropriate
section. This issue, inappropriate location of sentences discussing results is repeated throughout
the Results section and should be heavily revised.
Discussion
6) This section is nicely presented but should include a number of statements addressed in the
results section as mentioned above.
All in all this paper is nice but should be revised according to reviewer concerns in order to be
considered for publication.
Title: Features of defecation dysfunction among patients with Hirschsprung disease in early
childhood
Version: 1 Date: 20 Oct 2024
Reviewer:  Alessio Pini Prato
Reviewer's report:
The paper is intriguing but I have some concerns
English form should be improved throughout the text.
Materials and Methods
1) there are no statements regarding the power analysis performed to determine the number of
patients and controls. Even if no power analysis was done, this should be mentioned in the text.
2) No mention is done regarding the age and sex matching of cases and controls and if present
or not this aspect should be addressed
Results
3) It  is unclear to me the meaning of the following sentence: “ In our study healthy control
children who were < 3 years of age had completed toilet training”
4) It is unclear the population of HSCR we are dealing with. the sentence stating: “There was
no difference between patients with RSHD and healthy control children with respect to the
male:female ratio, age, and weight at follow-up (all, P>0.05)”  suggest a distorced epidemiology
in this series of patients. In fact, I would expect a dramatic male prepondrance  with a statistically
significant differences of male to female ratio when comparing rectosigmoid HSCR and healty
population. Even comparing rectosigmoid, long and ultra long J HSCR, we should observe
a 4/5:1 ratio in classic form decreasing to a nearly 1:1 ratio in total colonic or extended
aganglionosis. This aspect should be considered for a better rephrasing of results section or to
develop an adequate discussion.
5) the statement “ These findings indicated that an inadequate ability to feel or report the urge
to defecate occurred in all HD types and was more severe in DTHDs and AIHDs, which may be
attributed to damage from intact sensations. The intact sensation lies on the anal tract or dentate
line and can be damaged during PT surgery by a lower level of dissection or anastomosis at the
dentate line [31]” is a clear discussion of the results and it should be moved to  the appropriate
section. This issue, inappropriate location of sentences discussing results is repeated throughout
the Results section and should be heavily revised.
Discussion
6) This section is nicely presented but should include a number of statements addressed in the
results section as mentioned above.
All in all this paper is nice but should be revised according to reviewer concerns in order to be
considered for publication.
Please review this paper.
user
Title: Features of defecation dysfunction among patients with Hirschsprung disease in early
childhood
Version: 1 Date: 20 Oct 2024
Reviewer:  Alessio Pini Prato
Reviewer's report:
The paper is intriguing but I have some concerns
English form should be improved throughout the text.
Materials and Methods
1) there are no statements regarding the power analysis performed to determine the number of
patients and controls. Even if no power analysis was done, this should be mentioned in the text.
2) No mention is done regarding the age and sex matching of cases and controls and if present
or not this aspect should be addressed
Results
3) It  is unclear to me the meaning of the following sentence: “ In our study healthy control
children who were < 3 years of age had completed toilet training”
4) It is unclear the population of HSCR we are dealing with. the sentence stating: “There was
no difference between patients with RSHD and healthy control children with respect to the
male:female ratio, age, and weight at follow-up (all, P>0.05)”  suggest a distorced epidemiology
in this series of patients. In fact, I would expect a dramatic male prepondrance  with a statistically
significant differences of male to female ratio when comparing rectosigmoid HSCR and healty
population. Even comparing rectosigmoid, long and ultra long J HSCR, we should observe
a 4/5:1 ratio in classic form decreasing to a nearly 1:1 ratio in total colonic or extended
aganglionosis. This aspect should be considered for a better rephrasing of results section or to
develop an adequate discussion.
5) the statement “ These findings indicated that an inadequate ability to feel or report the urge
to defecate occurred in all HD types and was more severe in DTHDs and AIHDs, which may be
attributed to damage from intact sensations. The intact sensation lies on the anal tract or dentate
line and can be damaged during PT surgery by a lower level of dissection or anastomosis at the
dentate line [31]” is a clear discussion of the results and it should be moved to  the appropriate
section. This issue, inappropriate location of sentences discussing results is repeated throughout
the Results section and should be heavily revised.
Discussion
6) This section is nicely presented but should include a number of statements addressed in the
results section as mentioned above.
All in all this paper is nice but should be revised according to reviewer concerns in order to be
considered for publication.
assistant