Title: Benign hepaticojejunostomy strictures after pancreatoduodenectomy
Version: 4 Date: 04 Feb 2024
Reviewer's report:
1. In the Methods: according to a request provided by one of the previous reviewers, the authors
have provided a detailed description of the postoperative follow-up employed. However, I
feel that the most important point is still missing here. When do they establish that a biliary
anastomotic stricture is present? Is it always and only a radiologic definition? In this case,
did they employ a given diameter threshold to define the stenosis? This is pivotal for the
reproducibility of the study results.
2. In the Methods: a definition of preoperative and routine, early postoperative biliary duct
measurement is provided in the paragraph dedicated to biliary anastomosis stricture definition.
The authors are invited to move the last sentences of the paragraph accordingly.
3. In the Methods: ‘filamentous bile duct stenosis’ is inappropriate wording.  I would suggest
removing the adjective.
4. In the Methods and Figures: why were continuous variables described as mean only? I would
suggest using the median instead. In the figures, it should be specified whether means or medians
are reported.
5. In the Results: compared to the original submission, the authors have included a sentence
regarding a case in which a biliary anastomotic stricture occurred in a patient with bile cancer.
They reported an ‘improvement’ in the bile duct measurement from preop to postop. Why did
they do that? What is the sense of this detail?
6. In the Results, Multivariate analysis: formally speaking, this is a multivariable analysis.
Furthermore, they added the sentence: BHS occurred in 13 (7.4%) of the 175 cases reviewed,
11 (84.6%) of the 13 cases had a bile duct diameter of 8.8 mm or less, and 10 (76.9%) were
male. It seems inappropriate to present these data here. Instead, this should be incorporated in
the paragraph ‘comparison of the BHS and non-BHS groups’.
7. In the Results: the sentence: In all 13 cases in which the BHS had occurred, 539 days
(365-1959) had elapsed since the last ERC, with no recurrence of BHS. is unclear. What do the
authors mean? I would suggest removing this sentence.
8. In the Discussion: the authors state that postop cholangitis was not included in the
multivariable model. However, it seems to be included according to the revised table 3. Please
clarify.
9. General comment: despite being generally improved from the original submission, scientific
English writing still needs proofreading before publication. There are several occasions in which
writing sounds clumsy and inappropriate to the context. I would suggest having an expert
scientific writer involved who is fond of surgical and anatomical descriptions and data reporting.
Title: Benign hepaticojejunostomy strictures after pancreatoduodenectomy
Version: 4 Date: 04 Feb 2024
Reviewer's report:
1. In the Methods: according to a request provided by one of the previous reviewers, the authors
have provided a detailed description of the postoperative follow-up employed. However, I
feel that the most important point is still missing here. When do they establish that a biliary
anastomotic stricture is present? Is it always and only a radiologic definition? In this case,
did they employ a given diameter threshold to define the stenosis? This is pivotal for the
reproducibility of the study results.
2. In the Methods: a definition of preoperative and routine, early postoperative biliary duct
measurement is provided in the paragraph dedicated to biliary anastomosis stricture definition.
The authors are invited to move the last sentences of the paragraph accordingly.
3. In the Methods: ‘filamentous bile duct stenosis’ is inappropriate wording.  I would suggest
removing the adjective.
4. In the Methods and Figures: why were continuous variables described as mean only? I would
suggest using the median instead. In the figures, it should be specified whether means or medians
are reported.
5. In the Results: compared to the original submission, the authors have included a sentence
regarding a case in which a biliary anastomotic stricture occurred in a patient with bile cancer.
They reported an ‘improvement’ in the bile duct measurement from preop to postop. Why did
they do that? What is the sense of this detail?
6. In the Results, Multivariate analysis: formally speaking, this is a multivariable analysis.
Furthermore, they added the sentence: BHS occurred in 13 (7.4%) of the 175 cases reviewed,
11 (84.6%) of the 13 cases had a bile duct diameter of 8.8 mm or less, and 10 (76.9%) were
male. It seems inappropriate to present these data here. Instead, this should be incorporated in
the paragraph ‘comparison of the BHS and non-BHS groups’.
7. In the Results: the sentence: In all 13 cases in which the BHS had occurred, 539 days
(365-1959) had elapsed since the last ERC, with no recurrence of BHS. is unclear. What do the
authors mean? I would suggest removing this sentence.
8. In the Discussion: the authors state that postop cholangitis was not included in the
multivariable model. However, it seems to be included according to the revised table 3. Please
clarify.
9. General comment: despite being generally improved from the original submission, scientific
English writing still needs proofreading before publication. There are several occasions in which
writing sounds clumsy and inappropriate to the context. I would suggest having an expert
scientific writer involved who is fond of surgical and anatomical descriptions and data reporting.
Please review this paper.
user
Title: Benign hepaticojejunostomy strictures after pancreatoduodenectomy
Version: 4 Date: 04 Feb 2024
Reviewer's report:
1. In the Methods: according to a request provided by one of the previous reviewers, the authors
have provided a detailed description of the postoperative follow-up employed. However, I
feel that the most important point is still missing here. When do they establish that a biliary
anastomotic stricture is present? Is it always and only a radiologic definition? In this case,
did they employ a given diameter threshold to define the stenosis? This is pivotal for the
reproducibility of the study results.
2. In the Methods: a definition of preoperative and routine, early postoperative biliary duct
measurement is provided in the paragraph dedicated to biliary anastomosis stricture definition.
The authors are invited to move the last sentences of the paragraph accordingly.
3. In the Methods: ‘filamentous bile duct stenosis’ is inappropriate wording.  I would suggest
removing the adjective.
4. In the Methods and Figures: why were continuous variables described as mean only? I would
suggest using the median instead. In the figures, it should be specified whether means or medians
are reported.
5. In the Results: compared to the original submission, the authors have included a sentence
regarding a case in which a biliary anastomotic stricture occurred in a patient with bile cancer.
They reported an ‘improvement’ in the bile duct measurement from preop to postop. Why did
they do that? What is the sense of this detail?
6. In the Results, Multivariate analysis: formally speaking, this is a multivariable analysis.
Furthermore, they added the sentence: BHS occurred in 13 (7.4%) of the 175 cases reviewed,
11 (84.6%) of the 13 cases had a bile duct diameter of 8.8 mm or less, and 10 (76.9%) were
male. It seems inappropriate to present these data here. Instead, this should be incorporated in
the paragraph ‘comparison of the BHS and non-BHS groups’.
7. In the Results: the sentence: In all 13 cases in which the BHS had occurred, 539 days
(365-1959) had elapsed since the last ERC, with no recurrence of BHS. is unclear. What do the
authors mean? I would suggest removing this sentence.
8. In the Discussion: the authors state that postop cholangitis was not included in the
multivariable model. However, it seems to be included according to the revised table 3. Please
clarify.
9. General comment: despite being generally improved from the original submission, scientific
English writing still needs proofreading before publication. There are several occasions in which
writing sounds clumsy and inappropriate to the context. I would suggest having an expert
scientific writer involved who is fond of surgical and anatomical descriptions and data reporting.
assistant