Title: The Patient Perspective on Transanal Irrigation Treatment for Low Anterior Resection
Syndrome after Rectal Cancer Surgery -A Qualitative and Quantitative Study
Version: 1 Date: 11 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-The authors highlight the lack of a direct randomized control group during the follow-up
period, which is an important limitation. While the study builds on a previous RCT, without an
active comparison group during this stage, it is difficult to definitively attribute the observed
improvements to TAI alone. The authors mention this as a limitation but do not explore
alternative ways in which the control group could have been better incorporated into the analysis
(e.g., by directly comparing baseline and follow-up data in both groups).
-While the discussion highlights many positive outcomes of TAI, such as improved bowel
regularity and enhanced social participation, the analysis could benefit from a more nuanced
discussion of the negative aspects or limitations of TAI. Although the authors do mention
discomfort and pain during the procedure, they could have further expanded on how these issues
affect patient adherence, especially in the long term. For instance, a deeper exploration of the
psychological challenges or physical discomfort faced by some patients (e.g., pain, anxiety, or
inconvenience) would provide a more balanced view of the treatment. Discussing strategies to
mitigate these challenges would be helpful for clinicians considering TAI as a treatment option.
-Although the authors acknowledge the small sample size and dropout, they do not sufficiently
address the potential biases introduced by dropout. Given that only 28 out of 39 patients were
included in the final quantitative analysis, it is essential to explore whether the dropout was
random or if there were systematic differences between those who dropped out and those
who remained in the study. This could provide additional context for interpreting the results,
particularly regarding the generalizability of the findings.
Title: The Patient Perspective on Transanal Irrigation Treatment for Low Anterior Resection
Syndrome after Rectal Cancer Surgery -A Qualitative and Quantitative Study
Version: 1 Date: 11 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-The authors highlight the lack of a direct randomized control group during the follow-up
period, which is an important limitation. While the study builds on a previous RCT, without an
active comparison group during this stage, it is difficult to definitively attribute the observed
improvements to TAI alone. The authors mention this as a limitation but do not explore
alternative ways in which the control group could have been better incorporated into the analysis
(e.g., by directly comparing baseline and follow-up data in both groups).
-While the discussion highlights many positive outcomes of TAI, such as improved bowel
regularity and enhanced social participation, the analysis could benefit from a more nuanced
discussion of the negative aspects or limitations of TAI. Although the authors do mention
discomfort and pain during the procedure, they could have further expanded on how these issues
affect patient adherence, especially in the long term. For instance, a deeper exploration of the
psychological challenges or physical discomfort faced by some patients (e.g., pain, anxiety, or
inconvenience) would provide a more balanced view of the treatment. Discussing strategies to
mitigate these challenges would be helpful for clinicians considering TAI as a treatment option.
-Although the authors acknowledge the small sample size and dropout, they do not sufficiently
address the potential biases introduced by dropout. Given that only 28 out of 39 patients were
included in the final quantitative analysis, it is essential to explore whether the dropout was
random or if there were systematic differences between those who dropped out and those
who remained in the study. This could provide additional context for interpreting the results,
particularly regarding the generalizability of the findings.
Please review this paper.
user
Title: The Patient Perspective on Transanal Irrigation Treatment for Low Anterior Resection
Syndrome after Rectal Cancer Surgery -A Qualitative and Quantitative Study
Version: 1 Date: 11 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-The authors highlight the lack of a direct randomized control group during the follow-up
period, which is an important limitation. While the study builds on a previous RCT, without an
active comparison group during this stage, it is difficult to definitively attribute the observed
improvements to TAI alone. The authors mention this as a limitation but do not explore
alternative ways in which the control group could have been better incorporated into the analysis
(e.g., by directly comparing baseline and follow-up data in both groups).
-While the discussion highlights many positive outcomes of TAI, such as improved bowel
regularity and enhanced social participation, the analysis could benefit from a more nuanced
discussion of the negative aspects or limitations of TAI. Although the authors do mention
discomfort and pain during the procedure, they could have further expanded on how these issues
affect patient adherence, especially in the long term. For instance, a deeper exploration of the
psychological challenges or physical discomfort faced by some patients (e.g., pain, anxiety, or
inconvenience) would provide a more balanced view of the treatment. Discussing strategies to
mitigate these challenges would be helpful for clinicians considering TAI as a treatment option.
-Although the authors acknowledge the small sample size and dropout, they do not sufficiently
address the potential biases introduced by dropout. Given that only 28 out of 39 patients were
included in the final quantitative analysis, it is essential to explore whether the dropout was
random or if there were systematic differences between those who dropped out and those
who remained in the study. This could provide additional context for interpreting the results,
particularly regarding the generalizability of the findings.
assistant