Reviewer’s report  
Title: Role of preoperative biliary stents, bile contamination and antibiotic prophylaxis in 
surgical  site infections after  pancreaticoduodenectomy  
 
Version: 0 Date: 23 Nov 2015  
 
Reviewer: Fuyuhiko Motoi  
Reviewer’s report:  
1. The major obstacle for these types of retrospective studies (non -randomized study) is not 
to clarify the decision -making of the treatment. How to decide to undergo biliary ste nting 
placement (n=89) or not to undergo (n=13) for the patients with obstructive jaundice?  
 
2. How many patients showed cholangitis before biliary stenting? These patients must be 
treated by biliary decompression pre -operatively and have high risk for SSI.  
 
3. Did the patients (n=59) with repeated ERCP, including stent re -placement, showed high 
incident of SSI?  
 
4. There was a wide range of the duration of biliary stent placement (d8 -393). Did the 
duration of the stent placement affect the incident of deep SSI?  
 
5. There might be a significant difference of the duration of preoperative period between  
stented and non -stented group. Please show the pre -operative duration of each group. The 
difference might affect the surgical outcome.  
 
6. The conclusion of this study was that preoperative biliary stenting should be used only in 
selected patients. How to select the patients to undergo biliary stent placement? Please 
discuss the eligibility of this procedure.  
 
7. The sentence; The multivariate model was adjusted … (p10, Result), was confusing. 
Please show the precise data OR (CI), p value before and after ad justment.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which con trols are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you r ecommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please in dicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, consideri ng the following questions:  
 
1. Have you in the past five years received reimbursements, fees, fun ding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, e ither now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from t he publication of this manuscript, e ither now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the  content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the  content of the manuscript?  
 
5. Do you have any other fin ancial competing interests?  
 
6. Do you have any non -financial competing interests  in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on m y report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer’s report  
Title: Role of preoperative biliary stents, bile contamination and antibiotic prophylaxis in 
surgical  site infections after  pancreaticoduodenectomy  
 
Version: 0 Date: 23 Nov 2015  
 
Reviewer: Fuyuhiko Motoi  
Reviewer’s report:  
1. The major obstacle for these types of retrospective studies (non -randomized study) is not 
to clarify the decision -making of the treatment. How to decide to undergo biliary ste nting 
placement (n=89) or not to undergo (n=13) for the patients with obstructive jaundice?  
 
2. How many patients showed cholangitis before biliary stenting? These patients must be 
treated by biliary decompression pre -operatively and have high risk for SSI.  
 
3. Did the patients (n=59) with repeated ERCP, including stent re -placement, showed high 
incident of SSI?  
 
4. There was a wide range of the duration of biliary stent placement (d8 -393). Did the 
duration of the stent placement affect the incident of deep SSI?  
 
5. There might be a significant difference of the duration of preoperative period between  
stented and non -stented group. Please show the pre -operative duration of each group. The 
difference might affect the surgical outcome.  
 
6. The conclusion of this study was that preoperative biliary stenting should be used only in 
selected patients. How to select the patients to undergo biliary stent placement? Please 
discuss the eligibility of this procedure.  
 
7. The sentence; The multivariate model was adjusted … (p10, Result), was confusing. 
Please show the precise data OR (CI), p value before and after ad justment.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which con trols are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you r ecommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please in dicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, consideri ng the following questions:  
 
1. Have you in the past five years received reimbursements, fees, fun ding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, e ither now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from t he publication of this manuscript, e ither now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the  content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the  content of the manuscript?  
 
5. Do you have any other fin ancial competing interests?  
 
6. Do you have any non -financial competing interests  in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on m y report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer’s report  
Title: Role of preoperative biliary stents, bile contamination and antibiotic prophylaxis in 
surgical  site infections after  pancreaticoduodenectomy  
 
Version: 0 Date: 23 Nov 2015  
 
Reviewer: Fuyuhiko Motoi  
Reviewer’s report:  
1. The major obstacle for these types of retrospective studies (non -randomized study) is not 
to clarify the decision -making of the treatment. How to decide to undergo biliary ste nting 
placement (n=89) or not to undergo (n=13) for the patients with obstructive jaundice?  
 
2. How many patients showed cholangitis before biliary stenting? These patients must be 
treated by biliary decompression pre -operatively and have high risk for SSI.  
 
3. Did the patients (n=59) with repeated ERCP, including stent re -placement, showed high 
incident of SSI?  
 
4. There was a wide range of the duration of biliary stent placement (d8 -393). Did the 
duration of the stent placement affect the incident of deep SSI?  
 
5. There might be a significant difference of the duration of preoperative period between  
stented and non -stented group. Please show the pre -operative duration of each group. The 
difference might affect the surgical outcome.  
 
6. The conclusion of this study was that preoperative biliary stenting should be used only in 
selected patients. How to select the patients to undergo biliary stent placement? Please 
discuss the eligibility of this procedure.  
 
7. The sentence; The multivariate model was adjusted … (p10, Result), was confusing. 
Please show the precise data OR (CI), p value before and after ad justment.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which con trols are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you r ecommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please in dicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, consideri ng the following questions:  
 
1. Have you in the past five years received reimbursements, fees, fun ding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, e ither now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from t he publication of this manuscript, e ither now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the  content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the  content of the manuscript?  
 
5. Do you have any other fin ancial competing interests?  
 
6. Do you have any non -financial competing interests  in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on m y report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant