Reviewer ’s report  
 
Title: Indications and complications of intestinal stomas at a tertiary care hospital in a resource -
limited setting: A Tanzan ian experience  
 
Version: 1 Date: 20 Jun 2018  
 
Reviewer: Janice C. Colwell  
 
Reviewer's report:  
 
I enjoyed reading your well written article.  Here are my comments on your work.  The paper 
notes the purpose is "identified the factors associated with these complications, the study 
describes common indications, complications and management ".  The purpose as I read it is a 
descriptive study of the ostomy population at your facility. You might consider rewording the 
title. Did you collect BMI as that would have been interesting since so many studies suggest this 
is a risk factor for stoma com plications? I would suggest that stoma closure not be part of the 
paper, as it does not fit the purpose of the study. What was the time frame in which the patient 
was assessed for complications, was this done in house or at an outpatient clinic visit impor tant 
for the readers to know? Stoma site marking is supported in the literature as a method to prevent 
postoperative complications what percentage of patients were stoma site marked after surgery 
and by whom? Does your facility have stoma nurses and if so were they involved? It would be 
interesting to know if the patients got routine education by a nurse specialist. The term skin 
excoriation should not be used, excoriation means to abrade skin, the correct term used in stoma 
management is denuded peristomal  skin (caused by stool contacting the skin and causing 
irritation.)  Would recommend that the term excoriation be replaced with denuded peristomal 
skin through out the manuscript. Did not understand on page 8 line 22 what it meant that a 
person with an acq uired disease presented between one month and 12 years? What is definitive 
surgery not familiar with the term? Not sure if this is a term your readers know. Page five line 53 
notes that the study was conducted to describe common indications, complication a nd their 
management ….but there was nothing in the paper on the management of peristomal skin 
complications.  Need to either add management or drop management since there is nothing on 
peristomal skin management. I think the readers wound like to know the diagnosis of the patients 
with a bowel perforation, mechanical bowel obstruction as the ultimate diagnosis may affect the 
development of complications.  
 
Please consider more recent references such as:   
Management and complications of stomas. Bafford AC, Irani JL.  Surg Clin North AM 2013 
Feb;93(1):145 -66. 
 
The incidence of stoma and peristomal complications during the first 3 months after ostomy 
creation.  Salvadalena GG, Journal Wound Ostomy Continence N urse 2013 Jul -Aug;40(4):400 -
6.  
 
 
 
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 controls 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 manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate 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, considering the following ques tions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or  shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either 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 yo u 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 financial competing interests?  
 
6. Do you have any non -financial competing int erests 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 understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the a uthors' 
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 in cluded as confidential comments 
to the editor s, which wi ll not be published.   
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Indications and complications of intestinal stomas at a tertiary care hospital in a resource -
limited setting: A Tanzan ian experience  
 
Version: 1 Date: 20 Jun 2018  
 
Reviewer: Janice C. Colwell  
 
Reviewer's report:  
 
I enjoyed reading your well written article.  Here are my comments on your work.  The paper 
notes the purpose is "identified the factors associated with these complications, the study 
describes common indications, complications and management ".  The purpose as I read it is a 
descriptive study of the ostomy population at your facility. You might consider rewording the 
title. Did you collect BMI as that would have been interesting since so many studies suggest this 
is a risk factor for stoma com plications? I would suggest that stoma closure not be part of the 
paper, as it does not fit the purpose of the study. What was the time frame in which the patient 
was assessed for complications, was this done in house or at an outpatient clinic visit impor tant 
for the readers to know? Stoma site marking is supported in the literature as a method to prevent 
postoperative complications what percentage of patients were stoma site marked after surgery 
and by whom? Does your facility have stoma nurses and if so were they involved? It would be 
interesting to know if the patients got routine education by a nurse specialist. The term skin 
excoriation should not be used, excoriation means to abrade skin, the correct term used in stoma 
management is denuded peristomal  skin (caused by stool contacting the skin and causing 
irritation.)  Would recommend that the term excoriation be replaced with denuded peristomal 
skin through out the manuscript. Did not understand on page 8 line 22 what it meant that a 
person with an acq uired disease presented between one month and 12 years? What is definitive 
surgery not familiar with the term? Not sure if this is a term your readers know. Page five line 53 
notes that the study was conducted to describe common indications, complication a nd their 
management ….but there was nothing in the paper on the management of peristomal skin 
complications.  Need to either add management or drop management since there is nothing on 
peristomal skin management. I think the readers wound like to know the diagnosis of the patients 
with a bowel perforation, mechanical bowel obstruction as the ultimate diagnosis may affect the 
development of complications.  
 
Please consider more recent references such as:   
Management and complications of stomas. Bafford AC, Irani JL.  Surg Clin North AM 2013 
Feb;93(1):145 -66. 
 
The incidence of stoma and peristomal complications during the first 3 months after ostomy 
creation.  Salvadalena GG, Journal Wound Ostomy Continence N urse 2013 Jul -Aug;40(4):400 -
6.  
 
 
 
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 controls 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 manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate 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, considering the following ques tions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or  shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either 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 yo u 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 financial competing interests?  
 
6. Do you have any non -financial competing int erests 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 understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the a uthors' 
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 in cluded as confidential comments 
to the editor s, which wi ll not be published.   
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Indications and complications of intestinal stomas at a tertiary care hospital in a resource -
limited setting: A Tanzan ian experience  
 
Version: 1 Date: 20 Jun 2018  
 
Reviewer: Janice C. Colwell  
 
Reviewer's report:  
 
I enjoyed reading your well written article.  Here are my comments on your work.  The paper 
notes the purpose is "identified the factors associated with these complications, the study 
describes common indications, complications and management ".  The purpose as I read it is a 
descriptive study of the ostomy population at your facility. You might consider rewording the 
title. Did you collect BMI as that would have been interesting since so many studies suggest this 
is a risk factor for stoma com plications? I would suggest that stoma closure not be part of the 
paper, as it does not fit the purpose of the study. What was the time frame in which the patient 
was assessed for complications, was this done in house or at an outpatient clinic visit impor tant 
for the readers to know? Stoma site marking is supported in the literature as a method to prevent 
postoperative complications what percentage of patients were stoma site marked after surgery 
and by whom? Does your facility have stoma nurses and if so were they involved? It would be 
interesting to know if the patients got routine education by a nurse specialist. The term skin 
excoriation should not be used, excoriation means to abrade skin, the correct term used in stoma 
management is denuded peristomal  skin (caused by stool contacting the skin and causing 
irritation.)  Would recommend that the term excoriation be replaced with denuded peristomal 
skin through out the manuscript. Did not understand on page 8 line 22 what it meant that a 
person with an acq uired disease presented between one month and 12 years? What is definitive 
surgery not familiar with the term? Not sure if this is a term your readers know. Page five line 53 
notes that the study was conducted to describe common indications, complication a nd their 
management ….but there was nothing in the paper on the management of peristomal skin 
complications.  Need to either add management or drop management since there is nothing on 
peristomal skin management. I think the readers wound like to know the diagnosis of the patients 
with a bowel perforation, mechanical bowel obstruction as the ultimate diagnosis may affect the 
development of complications.  
 
Please consider more recent references such as:   
Management and complications of stomas. Bafford AC, Irani JL.  Surg Clin North AM 2013 
Feb;93(1):145 -66. 
 
The incidence of stoma and peristomal complications during the first 3 months after ostomy 
creation.  Salvadalena GG, Journal Wound Ostomy Continence N urse 2013 Jul -Aug;40(4):400 -
6.  
 
 
 
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 controls 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 manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate 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, considering the following ques tions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or  shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either 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 yo u 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 financial competing interests?  
 
6. Do you have any non -financial competing int erests 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 understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the a uthors' 
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 in cluded as confidential comments 
to the editor s, which wi ll not be published.   
 
I agree to the open peer review policy of the journal  
assistant