Title: The Short-term Effect of Laparoscopic Sleeve Gastrectomy with His Angle
Reconstruction (LSG-His) on Gastroesophageal Reflux Disease
Version: 4 Date: 20 Jun 2025
Reviewer:  Komol Chaivanijchaya
Reviewer's report:
The manuscript is generally well-structured, the methodology is clearly described, and the
findings are of interest to the surgical and bariatric community.
However, several issues require clarification or further elaboration to strengthen the manuscript
Here are my comments.
1. Study Design and Clarity
The manuscript is described as a "cohort study" and “observational study,” but it would be
helpful to clarify whether the study was retrospective or prospective. While data collection
appears retrospective, the surgical procedures and follow-up seem prospective. Please clarify
the study design explicitly.
2. Patient Allocation and Selection Bias
As patients self-selected the procedure type after discussion with surgeons, this introduces
potential selection bias. Please elaborate more on how this bias was addressed or minimized
(e.g., was propensity score matching considered?).
3. Definition of GERD Outcomes
The study relies solely on subjective questionnaire scores (GERD-Q and RD-Q) for reflux
evaluation. While this is acceptable in early-phase studies, the absence of objective measures
like 24-hour pH monitoring or endoscopy for all patients limits the strength of conclusions.
Consider acknowledging this as a more prominent limitation.
4. Innovation and Clinical Relevance
The concept of angle of His reconstruction is compelling, yet the novelty should be more clearly
emphasized. Consider citing whether similar techniques have been trialed previously in bariatric
surgery, and how LSG-His is technically and conceptually distinct from fundoplication or hiatal
hernia repair.
Title: The Short-term Effect of Laparoscopic Sleeve Gastrectomy with His Angle
Reconstruction (LSG-His) on Gastroesophageal Reflux Disease
Version: 4 Date: 20 Jun 2025
Reviewer:  Komol Chaivanijchaya
Reviewer's report:
The manuscript is generally well-structured, the methodology is clearly described, and the
findings are of interest to the surgical and bariatric community.
However, several issues require clarification or further elaboration to strengthen the manuscript
Here are my comments.
1. Study Design and Clarity
The manuscript is described as a "cohort study" and “observational study,” but it would be
helpful to clarify whether the study was retrospective or prospective. While data collection
appears retrospective, the surgical procedures and follow-up seem prospective. Please clarify
the study design explicitly.
2. Patient Allocation and Selection Bias
As patients self-selected the procedure type after discussion with surgeons, this introduces
potential selection bias. Please elaborate more on how this bias was addressed or minimized
(e.g., was propensity score matching considered?).
3. Definition of GERD Outcomes
The study relies solely on subjective questionnaire scores (GERD-Q and RD-Q) for reflux
evaluation. While this is acceptable in early-phase studies, the absence of objective measures
like 24-hour pH monitoring or endoscopy for all patients limits the strength of conclusions.
Consider acknowledging this as a more prominent limitation.
4. Innovation and Clinical Relevance
The concept of angle of His reconstruction is compelling, yet the novelty should be more clearly
emphasized. Consider citing whether similar techniques have been trialed previously in bariatric
surgery, and how LSG-His is technically and conceptually distinct from fundoplication or hiatal
hernia repair.
Please review this paper.
user
Title: The Short-term Effect of Laparoscopic Sleeve Gastrectomy with His Angle
Reconstruction (LSG-His) on Gastroesophageal Reflux Disease
Version: 4 Date: 20 Jun 2025
Reviewer:  Komol Chaivanijchaya
Reviewer's report:
The manuscript is generally well-structured, the methodology is clearly described, and the
findings are of interest to the surgical and bariatric community.
However, several issues require clarification or further elaboration to strengthen the manuscript
Here are my comments.
1. Study Design and Clarity
The manuscript is described as a "cohort study" and “observational study,” but it would be
helpful to clarify whether the study was retrospective or prospective. While data collection
appears retrospective, the surgical procedures and follow-up seem prospective. Please clarify
the study design explicitly.
2. Patient Allocation and Selection Bias
As patients self-selected the procedure type after discussion with surgeons, this introduces
potential selection bias. Please elaborate more on how this bias was addressed or minimized
(e.g., was propensity score matching considered?).
3. Definition of GERD Outcomes
The study relies solely on subjective questionnaire scores (GERD-Q and RD-Q) for reflux
evaluation. While this is acceptable in early-phase studies, the absence of objective measures
like 24-hour pH monitoring or endoscopy for all patients limits the strength of conclusions.
Consider acknowledging this as a more prominent limitation.
4. Innovation and Clinical Relevance
The concept of angle of His reconstruction is compelling, yet the novelty should be more clearly
emphasized. Consider citing whether similar techniques have been trialed previously in bariatric
surgery, and how LSG-His is technically and conceptually distinct from fundoplication or hiatal
hernia repair.
assistant