Title: Prediction and management of strangulated bowel obstruction: A multi-dimensional
model analysis
Version: 2 Date: 03 May 2022
Reviewer:  Ernst Fredericks
Reviewer's report:
Review Report: Prediction and management of strangulated bowel obstruction: A multi-omics
model analysis.
Thank you for asking me to review the above retrospective review of small bowel obstruction
comparing simple vs strangulated bowel obstruction. Sixteen percent of the study population had
strangulation while the majority had simple obstruction. Clinical and radiological parameters
were evaluated for significance to predict outcome.
I cannot recommend the publication of this manuscript in its current form on the following
grounds: The authors oversimplify an otherwise complex clinical management problem. My
biggest concern is with the patient characteristics. The majority of patients presenting with small
bowel obstruction managed conservatively are those who previously had abdominal surgery –
the adhesive small bowel obstruction group. This is the challenging group where conservative vs
operative management is often a dilemma. History of previous surgery in this study was also high
at 70% as shown in the demographic details table. It would have been useful to review the data
of those patients with adhesive small bowel obstruction, at least as a subgroup. The indications
for the previous surgery, type of surgery performed as well as the number of operations should
have been included in the analysis. Lumping all patients in 1 group does not allow to generate
a clear management pathway for each of the 2 divergent groups.
The clinical and radiological parameters evaluated for significance are all well known and
have been described in previous publications (Tong et al 2020, Zielinski et al 2016). Logistic
regression analysis between those and this study is comparable, although an exclusion from this
study was the CRP, which others have found useful in guiding earlier operative intervention
(Ten Broek et al 2017, Deng et al 2019).
It is not clear from the text what treatment the patients received and what their outcomes were.
Did everyone receive surgical exploration? How was the applicability of the model judged? How
accurately did the model predict need for surgery and avoiding re-operation? Re-admission rates
post admission for adhesive small bowel obstruction are high and it is valuable to know whether
prediction with this model could accurately prevent this.  Too many important factors are not
addressed by this retrospective analysis.
The data analysis and language use are generally acceptable in this manuscript.
Thank you.
Title: Prediction and management of strangulated bowel obstruction: A multi-dimensional
model analysis
Version: 2 Date: 03 May 2022
Reviewer:  Ernst Fredericks
Reviewer's report:
Review Report: Prediction and management of strangulated bowel obstruction: A multi-omics
model analysis.
Thank you for asking me to review the above retrospective review of small bowel obstruction
comparing simple vs strangulated bowel obstruction. Sixteen percent of the study population had
strangulation while the majority had simple obstruction. Clinical and radiological parameters
were evaluated for significance to predict outcome.
I cannot recommend the publication of this manuscript in its current form on the following
grounds: The authors oversimplify an otherwise complex clinical management problem. My
biggest concern is with the patient characteristics. The majority of patients presenting with small
bowel obstruction managed conservatively are those who previously had abdominal surgery –
the adhesive small bowel obstruction group. This is the challenging group where conservative vs
operative management is often a dilemma. History of previous surgery in this study was also high
at 70% as shown in the demographic details table. It would have been useful to review the data
of those patients with adhesive small bowel obstruction, at least as a subgroup. The indications
for the previous surgery, type of surgery performed as well as the number of operations should
have been included in the analysis. Lumping all patients in 1 group does not allow to generate
a clear management pathway for each of the 2 divergent groups.
The clinical and radiological parameters evaluated for significance are all well known and
have been described in previous publications (Tong et al 2020, Zielinski et al 2016). Logistic
regression analysis between those and this study is comparable, although an exclusion from this
study was the CRP, which others have found useful in guiding earlier operative intervention
(Ten Broek et al 2017, Deng et al 2019).
It is not clear from the text what treatment the patients received and what their outcomes were.
Did everyone receive surgical exploration? How was the applicability of the model judged? How
accurately did the model predict need for surgery and avoiding re-operation? Re-admission rates
post admission for adhesive small bowel obstruction are high and it is valuable to know whether
prediction with this model could accurately prevent this.  Too many important factors are not
addressed by this retrospective analysis.
The data analysis and language use are generally acceptable in this manuscript.
Thank you.
Please review this paper.
user
Title: Prediction and management of strangulated bowel obstruction: A multi-dimensional
model analysis
Version: 2 Date: 03 May 2022
Reviewer:  Ernst Fredericks
Reviewer's report:
Review Report: Prediction and management of strangulated bowel obstruction: A multi-omics
model analysis.
Thank you for asking me to review the above retrospective review of small bowel obstruction
comparing simple vs strangulated bowel obstruction. Sixteen percent of the study population had
strangulation while the majority had simple obstruction. Clinical and radiological parameters
were evaluated for significance to predict outcome.
I cannot recommend the publication of this manuscript in its current form on the following
grounds: The authors oversimplify an otherwise complex clinical management problem. My
biggest concern is with the patient characteristics. The majority of patients presenting with small
bowel obstruction managed conservatively are those who previously had abdominal surgery –
the adhesive small bowel obstruction group. This is the challenging group where conservative vs
operative management is often a dilemma. History of previous surgery in this study was also high
at 70% as shown in the demographic details table. It would have been useful to review the data
of those patients with adhesive small bowel obstruction, at least as a subgroup. The indications
for the previous surgery, type of surgery performed as well as the number of operations should
have been included in the analysis. Lumping all patients in 1 group does not allow to generate
a clear management pathway for each of the 2 divergent groups.
The clinical and radiological parameters evaluated for significance are all well known and
have been described in previous publications (Tong et al 2020, Zielinski et al 2016). Logistic
regression analysis between those and this study is comparable, although an exclusion from this
study was the CRP, which others have found useful in guiding earlier operative intervention
(Ten Broek et al 2017, Deng et al 2019).
It is not clear from the text what treatment the patients received and what their outcomes were.
Did everyone receive surgical exploration? How was the applicability of the model judged? How
accurately did the model predict need for surgery and avoiding re-operation? Re-admission rates
post admission for adhesive small bowel obstruction are high and it is valuable to know whether
prediction with this model could accurately prevent this.  Too many important factors are not
addressed by this retrospective analysis.
The data analysis and language use are generally acceptable in this manuscript.
Thank you.
assistant