Title: Perioperative outcomes of the surgical management of achalasia in two tertiary
Cameroonian hospitals: a cohort study
Version: 5 Date: 15 Feb 2024
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several
testable research questions? (Brief or other article types: is there a clear objective?)
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with sufficient technical rigor to
allow confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your concerns sufficiently
for you to now recommend the work as a technically sound contribution? If not, can further
revisions be made to make the work technically sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: HAVE THE AUTHORS  ANSWERED ALL YOUR QUESTIONS?
Yes thank you.  Thank you authors
HAVE  THE AUTHORS RESPONDED APPROPRIATELY TO YOUR  QUESTIONS
YES I agree with all the authors responses.  Well done authors!!!
IMPRESSION:
This an excellent report of two Camerooninan hospitals 10 yr experience with the operative
treatment of achalasia. This report involves 29 patients  out of 31 operated by some form of
Hellers myotomy ( about 75% open and 25% laparoscopic) with excellent operative results
and a very good follow up >90%! They show a female predominance and not unexpectedly
a long preoperative duration of symptoms related to several factors including physicians  not
recognizing this unusual disease, a resource-strapped society, and overlooking  of the diagnosis
after just endoscopy alone early in the disease before substantial esophageal dialtion. This paper
has a lot to offer for the African medical community.
ADDITIONAL REQUESTS/SUGGESTIONS:
SUGGESTIONS to improve the manuscript
I have re-read the entire manuscript and offer only minor suggestions to improve the readability.
Authors this is an excellent series with laudable results -WELL DONE! Impressive results!
1. Line 33. It would read better if you reworded it as follows: 'Data on the management of
achalsia using a Heller myotomy is limited in Africa; thus our aim was to determine••••••
2. Line 43.   round of percentage
3. Line 44 delete comma and add “via”
4. Line 61 add the words “of the"  after “Achalsia”
5. line 67 change gender to sex. Sex is the genotype and important if more common in one sex
over the other
6. Line 67 delete evoked and change to “suspected”
7.  Line  84 change  “there” to  “they “
8. Line 122 use abbreviation AC
9. I will suggest something that you the authors and the editors can consider. With 29 patients,
most all statistical comparisons will lack adequate power to make a robust statistical comparison.
If I were to write the paper,  I would say  “the statistics were used to suggest potential differences
to study in the futures with an adequately powered study”. This is your call but others  will
criticize you if you emphasize the statistics too much
10. Line 146. First edit the  abbreviation . But then —-Well done authors to get follow up on
virtually ALL patients-Very impressive!
11. Line 176 sorry but you need to reference this classification.
12. Lines 182-184. Do these sentences refer to the infants? If not, put the infant data after these
two sentences. If they do refer to the infants, then say so
13. Line 186 change to dilatation
14. Line 189 round off percentages
15.  Line 196. Delete the phrase “with no statistically significant differences.” Too few patients
are available  to make this comparison.
16. Line 122. Say ' superficial wound infection" not surgical site infection. Because there  can
be deep space SSIs
17. Lines 229-231 excellent and very interesting so much what different than in my country
18. Line 235 and 253 replace “device” with “procedure”
Overall authors. Very very well done a real service to the African medical community. It would
be especially interesting if a female predominance persisted across many African countries.
Title: Perioperative outcomes of the surgical management of achalasia in two tertiary
Cameroonian hospitals: a cohort study
Version: 5 Date: 15 Feb 2024
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several
testable research questions? (Brief or other article types: is there a clear objective?)
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with sufficient technical rigor to
allow confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your concerns sufficiently
for you to now recommend the work as a technically sound contribution? If not, can further
revisions be made to make the work technically sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: HAVE THE AUTHORS  ANSWERED ALL YOUR QUESTIONS?
Yes thank you.  Thank you authors
HAVE  THE AUTHORS RESPONDED APPROPRIATELY TO YOUR  QUESTIONS
YES I agree with all the authors responses.  Well done authors!!!
IMPRESSION:
This an excellent report of two Camerooninan hospitals 10 yr experience with the operative
treatment of achalasia. This report involves 29 patients  out of 31 operated by some form of
Hellers myotomy ( about 75% open and 25% laparoscopic) with excellent operative results
and a very good follow up >90%! They show a female predominance and not unexpectedly
a long preoperative duration of symptoms related to several factors including physicians  not
recognizing this unusual disease, a resource-strapped society, and overlooking  of the diagnosis
after just endoscopy alone early in the disease before substantial esophageal dialtion. This paper
has a lot to offer for the African medical community.
ADDITIONAL REQUESTS/SUGGESTIONS:
SUGGESTIONS to improve the manuscript
I have re-read the entire manuscript and offer only minor suggestions to improve the readability.
Authors this is an excellent series with laudable results -WELL DONE! Impressive results!
1. Line 33. It would read better if you reworded it as follows: 'Data on the management of
achalsia using a Heller myotomy is limited in Africa; thus our aim was to determine••••••
2. Line 43.   round of percentage
3. Line 44 delete comma and add “via”
4. Line 61 add the words “of the"  after “Achalsia”
5. line 67 change gender to sex. Sex is the genotype and important if more common in one sex
over the other
6. Line 67 delete evoked and change to “suspected”
7.  Line  84 change  “there” to  “they “
8. Line 122 use abbreviation AC
9. I will suggest something that you the authors and the editors can consider. With 29 patients,
most all statistical comparisons will lack adequate power to make a robust statistical comparison.
If I were to write the paper,  I would say  “the statistics were used to suggest potential differences
to study in the futures with an adequately powered study”. This is your call but others  will
criticize you if you emphasize the statistics too much
10. Line 146. First edit the  abbreviation . But then —-Well done authors to get follow up on
virtually ALL patients-Very impressive!
11. Line 176 sorry but you need to reference this classification.
12. Lines 182-184. Do these sentences refer to the infants? If not, put the infant data after these
two sentences. If they do refer to the infants, then say so
13. Line 186 change to dilatation
14. Line 189 round off percentages
15.  Line 196. Delete the phrase “with no statistically significant differences.” Too few patients
are available  to make this comparison.
16. Line 122. Say ' superficial wound infection" not surgical site infection. Because there  can
be deep space SSIs
17. Lines 229-231 excellent and very interesting so much what different than in my country
18. Line 235 and 253 replace “device” with “procedure”
Overall authors. Very very well done a real service to the African medical community. It would
be especially interesting if a female predominance persisted across many African countries.
Please review this paper.
user
Title: Perioperative outcomes of the surgical management of achalasia in two tertiary
Cameroonian hospitals: a cohort study
Version: 5 Date: 15 Feb 2024
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several
testable research questions? (Brief or other article types: is there a clear objective?)
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with sufficient technical rigor to
allow confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your concerns sufficiently
for you to now recommend the work as a technically sound contribution? If not, can further
revisions be made to make the work technically sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: HAVE THE AUTHORS  ANSWERED ALL YOUR QUESTIONS?
Yes thank you.  Thank you authors
HAVE  THE AUTHORS RESPONDED APPROPRIATELY TO YOUR  QUESTIONS
YES I agree with all the authors responses.  Well done authors!!!
IMPRESSION:
This an excellent report of two Camerooninan hospitals 10 yr experience with the operative
treatment of achalasia. This report involves 29 patients  out of 31 operated by some form of
Hellers myotomy ( about 75% open and 25% laparoscopic) with excellent operative results
and a very good follow up >90%! They show a female predominance and not unexpectedly
a long preoperative duration of symptoms related to several factors including physicians  not
recognizing this unusual disease, a resource-strapped society, and overlooking  of the diagnosis
after just endoscopy alone early in the disease before substantial esophageal dialtion. This paper
has a lot to offer for the African medical community.
ADDITIONAL REQUESTS/SUGGESTIONS:
SUGGESTIONS to improve the manuscript
I have re-read the entire manuscript and offer only minor suggestions to improve the readability.
Authors this is an excellent series with laudable results -WELL DONE! Impressive results!
1. Line 33. It would read better if you reworded it as follows: 'Data on the management of
achalsia using a Heller myotomy is limited in Africa; thus our aim was to determine••••••
2. Line 43.   round of percentage
3. Line 44 delete comma and add “via”
4. Line 61 add the words “of the"  after “Achalsia”
5. line 67 change gender to sex. Sex is the genotype and important if more common in one sex
over the other
6. Line 67 delete evoked and change to “suspected”
7.  Line  84 change  “there” to  “they “
8. Line 122 use abbreviation AC
9. I will suggest something that you the authors and the editors can consider. With 29 patients,
most all statistical comparisons will lack adequate power to make a robust statistical comparison.
If I were to write the paper,  I would say  “the statistics were used to suggest potential differences
to study in the futures with an adequately powered study”. This is your call but others  will
criticize you if you emphasize the statistics too much
10. Line 146. First edit the  abbreviation . But then —-Well done authors to get follow up on
virtually ALL patients-Very impressive!
11. Line 176 sorry but you need to reference this classification.
12. Lines 182-184. Do these sentences refer to the infants? If not, put the infant data after these
two sentences. If they do refer to the infants, then say so
13. Line 186 change to dilatation
14. Line 189 round off percentages
15.  Line 196. Delete the phrase “with no statistically significant differences.” Too few patients
are available  to make this comparison.
16. Line 122. Say ' superficial wound infection" not surgical site infection. Because there  can
be deep space SSIs
17. Lines 229-231 excellent and very interesting so much what different than in my country
18. Line 235 and 253 replace “device” with “procedure”
Overall authors. Very very well done a real service to the African medical community. It would
be especially interesting if a female predominance persisted across many African countries.
assistant