Reviewer's report
Title:Long Intestinal Tube Splinting Prevent Postoperative Adhesive Small Bowel
Obstruction in Sclerosing Encapsulating Peritonitis
Version:3Date:8 November 2013
Reviewer: Marica Galati
Reviewer's report:
Mayor Compulsory Revisions
I think this is a very interesting manuscript about a rare disease such as SEP.
The paper offers good discussion about differential diagnosis of intestinal
obstruction. Indeed is very important to have awareness of this condition as a
possible etiological factor in order to facilitate pre-operative diagnosis, prevent
inadvertent bowel damage at laparoscopy and unnecessary bowel resection at
laparotomy.
Although the clinical relevance is unquestionable, perhaps the statistical
significance of the findings is lacking. Indeed long intestinal tube splinting was
performed in 33 patients in addition to the excision of the fibrotic membrane,
while only 11 patients received simple adhesiolysis. There is a low probability of
detecting a significant difference between the mentioned study groups, since the
researchers would need a sample size of at least 28-30 patients in the control
arm, to show clear benefits to the individual receiving the additional treatment.
Finding an accurate sample, is one of the biggest problems facing those
attempting research.
The direct relationship between sample size and power is critical to interpreting
the conclusions that can be deduced from a study[1].
The failure to detect a clinically important difference between 2 groups can occur
as the result of inadequate sample size [2-3]. This occurrence is more likely in
studies involving rare events, but it can also be a hindrance to studies involving
more common events.
Obviously the incidence of SEP is so rare that it would be almost impossible to
find a sample population large enough to attain statistically significant results.
Furthermore this is a retrospective study.
In my opinion we should not focus on P values alone to decide whether a
treatment is clinically useful, but we have to take in account both the clinical and
the statistical significance of the findings.
However it would be a mistake to conclude, just because the study has the
largest number of patients and the longer follow-up compared with previously
published papers, that we can draw strong conclusions about efficacy of tube
splinting in preventing ASBO in SEP patients.
Discretionary Revisions
It is not clear the reasoning according to which the surgeons decided to use or
not tube splinting.
1. Sheps S Sample size and power J Invest Surg 1993;6469- 475
2. Phillips WCScott JABlasczcynski G The significance of “no siginificance”: what
a negative statistical test really means AJR Am J Roentgenol 1983;141203- 206
3. Javitt JC When does the failure to find a difference mean that there is none?
Arch Ophthalmol 1989;1071034- 1040
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests
Reviewer's report
Title:Long Intestinal Tube Splinting Prevent Postoperative Adhesive Small Bowel
Obstruction in Sclerosing Encapsulating Peritonitis
Version:3Date:8 November 2013
Reviewer: Marica Galati
Reviewer's report:
Mayor Compulsory Revisions
I think this is a very interesting manuscript about a rare disease such as SEP.
The paper offers good discussion about differential diagnosis of intestinal
obstruction. Indeed is very important to have awareness of this condition as a
possible etiological factor in order to facilitate pre-operative diagnosis, prevent
inadvertent bowel damage at laparoscopy and unnecessary bowel resection at
laparotomy.
Although the clinical relevance is unquestionable, perhaps the statistical
significance of the findings is lacking. Indeed long intestinal tube splinting was
performed in 33 patients in addition to the excision of the fibrotic membrane,
while only 11 patients received simple adhesiolysis. There is a low probability of
detecting a significant difference between the mentioned study groups, since the
researchers would need a sample size of at least 28-30 patients in the control
arm, to show clear benefits to the individual receiving the additional treatment.
Finding an accurate sample, is one of the biggest problems facing those
attempting research.
The direct relationship between sample size and power is critical to interpreting
the conclusions that can be deduced from a study[1].
The failure to detect a clinically important difference between 2 groups can occur
as the result of inadequate sample size [2-3]. This occurrence is more likely in
studies involving rare events, but it can also be a hindrance to studies involving
more common events.
Obviously the incidence of SEP is so rare that it would be almost impossible to
find a sample population large enough to attain statistically significant results.
Furthermore this is a retrospective study.
In my opinion we should not focus on P values alone to decide whether a
treatment is clinically useful, but we have to take in account both the clinical and
the statistical significance of the findings.
However it would be a mistake to conclude, just because the study has the
largest number of patients and the longer follow-up compared with previously
published papers, that we can draw strong conclusions about efficacy of tube
splinting in preventing ASBO in SEP patients.
Discretionary Revisions
It is not clear the reasoning according to which the surgeons decided to use or
not tube splinting.
1. Sheps S Sample size and power J Invest Surg 1993;6469- 475
2. Phillips WCScott JABlasczcynski G The significance of “no siginificance”: what
a negative statistical test really means AJR Am J Roentgenol 1983;141203- 206
3. Javitt JC When does the failure to find a difference mean that there is none?
Arch Ophthalmol 1989;1071034- 1040
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests
Please review this paper.
user
Reviewer's report
Title:Long Intestinal Tube Splinting Prevent Postoperative Adhesive Small Bowel
Obstruction in Sclerosing Encapsulating Peritonitis
Version:3Date:8 November 2013
Reviewer: Marica Galati
Reviewer's report:
Mayor Compulsory Revisions
I think this is a very interesting manuscript about a rare disease such as SEP.
The paper offers good discussion about differential diagnosis of intestinal
obstruction. Indeed is very important to have awareness of this condition as a
possible etiological factor in order to facilitate pre-operative diagnosis, prevent
inadvertent bowel damage at laparoscopy and unnecessary bowel resection at
laparotomy.
Although the clinical relevance is unquestionable, perhaps the statistical
significance of the findings is lacking. Indeed long intestinal tube splinting was
performed in 33 patients in addition to the excision of the fibrotic membrane,
while only 11 patients received simple adhesiolysis. There is a low probability of
detecting a significant difference between the mentioned study groups, since the
researchers would need a sample size of at least 28-30 patients in the control
arm, to show clear benefits to the individual receiving the additional treatment.
Finding an accurate sample, is one of the biggest problems facing those
attempting research.
The direct relationship between sample size and power is critical to interpreting
the conclusions that can be deduced from a study[1].
The failure to detect a clinically important difference between 2 groups can occur
as the result of inadequate sample size [2-3]. This occurrence is more likely in
studies involving rare events, but it can also be a hindrance to studies involving
more common events.
Obviously the incidence of SEP is so rare that it would be almost impossible to
find a sample population large enough to attain statistically significant results.
Furthermore this is a retrospective study.
In my opinion we should not focus on P values alone to decide whether a
treatment is clinically useful, but we have to take in account both the clinical and
the statistical significance of the findings.
However it would be a mistake to conclude, just because the study has the
largest number of patients and the longer follow-up compared with previously
published papers, that we can draw strong conclusions about efficacy of tube
splinting in preventing ASBO in SEP patients.
Discretionary Revisions
It is not clear the reasoning according to which the surgeons decided to use or
not tube splinting.
1. Sheps S Sample size and power J Invest Surg 1993;6469- 475
2. Phillips WCScott JABlasczcynski G The significance of “no siginificance”: what
a negative statistical test really means AJR Am J Roentgenol 1983;141203- 206
3. Javitt JC When does the failure to find a difference mean that there is none?
Arch Ophthalmol 1989;1071034- 1040
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests
assistant