Title: IS CHEMODENERVATION WITH INCOBOTULINUMTOXINA AN
ALTERNATIVE TO INVASIVE CHRONIC ANAL FISSURE TREATMENTS?
Version: 2 Date: 05 Jun 2024
Reviewer:  Wilhelm Graf
Reviewer's report:
Thanks for the opportunity to review the manuscript ” IS NEUROMODULATION WITH
INCOBOTULINUMTOXINA AN ALTERNATIVE TO SPHINCTEROTOMY?” which is a
monocenter study analyzing outcomes after Botox type A for treatments of anal fissures.. My
comments are listed below:
1. I recommend the authors to avoid the term neuromodulation in the title and in the paper.
Neuromodulation is mainly used for electrical modulation of nerves and the term is closely
connected with sacral neuromodulation for fecal incontinence and related applications.
2. Please also avoid the term “anal laterals”. The location could be described as lateral and
posterior.
3. Myastenia gravis is misspelled.
4. In the overview of treatment options in the introduction, the surgical alternatives should be
briefly mentioned.
5. Squeeze pressure is described as reflecting IAS function which is not true. Please amend!
6. In assessment of safety – did you follow any established grading system?
7. Could the manometry assessment be more clearly described or referenced?
8. I assume that a non parametric test is better suited for scale values such as Wexner score etc?
9. The judgement of healing could be more clearly described, i.e. were the assessment of the
fissure based on examination under anesthesia or without. How was it performed?
10. Please define “psychiatric disorder”.
11. Maybe logistic regression is meaningless because of the limited numbers. Proportions are
better.
12. Did you include patients with IBD or did they fall under the exclusion criteria “ non
idiopathic”?
13. Finally, I believe the authors should acknowledge and further stress that the efficacy must
be interpreted in light of the abscence of a control group and that the placebo effect might affect
results.
Title: IS CHEMODENERVATION WITH INCOBOTULINUMTOXINA AN
ALTERNATIVE TO INVASIVE CHRONIC ANAL FISSURE TREATMENTS?
Version: 2 Date: 05 Jun 2024
Reviewer:  Wilhelm Graf
Reviewer's report:
Thanks for the opportunity to review the manuscript ” IS NEUROMODULATION WITH
INCOBOTULINUMTOXINA AN ALTERNATIVE TO SPHINCTEROTOMY?” which is a
monocenter study analyzing outcomes after Botox type A for treatments of anal fissures.. My
comments are listed below:
1. I recommend the authors to avoid the term neuromodulation in the title and in the paper.
Neuromodulation is mainly used for electrical modulation of nerves and the term is closely
connected with sacral neuromodulation for fecal incontinence and related applications.
2. Please also avoid the term “anal laterals”. The location could be described as lateral and
posterior.
3. Myastenia gravis is misspelled.
4. In the overview of treatment options in the introduction, the surgical alternatives should be
briefly mentioned.
5. Squeeze pressure is described as reflecting IAS function which is not true. Please amend!
6. In assessment of safety – did you follow any established grading system?
7. Could the manometry assessment be more clearly described or referenced?
8. I assume that a non parametric test is better suited for scale values such as Wexner score etc?
9. The judgement of healing could be more clearly described, i.e. were the assessment of the
fissure based on examination under anesthesia or without. How was it performed?
10. Please define “psychiatric disorder”.
11. Maybe logistic regression is meaningless because of the limited numbers. Proportions are
better.
12. Did you include patients with IBD or did they fall under the exclusion criteria “ non
idiopathic”?
13. Finally, I believe the authors should acknowledge and further stress that the efficacy must
be interpreted in light of the abscence of a control group and that the placebo effect might affect
results.
Please review this paper.
user
Title: IS CHEMODENERVATION WITH INCOBOTULINUMTOXINA AN
ALTERNATIVE TO INVASIVE CHRONIC ANAL FISSURE TREATMENTS?
Version: 2 Date: 05 Jun 2024
Reviewer:  Wilhelm Graf
Reviewer's report:
Thanks for the opportunity to review the manuscript ” IS NEUROMODULATION WITH
INCOBOTULINUMTOXINA AN ALTERNATIVE TO SPHINCTEROTOMY?” which is a
monocenter study analyzing outcomes after Botox type A for treatments of anal fissures.. My
comments are listed below:
1. I recommend the authors to avoid the term neuromodulation in the title and in the paper.
Neuromodulation is mainly used for electrical modulation of nerves and the term is closely
connected with sacral neuromodulation for fecal incontinence and related applications.
2. Please also avoid the term “anal laterals”. The location could be described as lateral and
posterior.
3. Myastenia gravis is misspelled.
4. In the overview of treatment options in the introduction, the surgical alternatives should be
briefly mentioned.
5. Squeeze pressure is described as reflecting IAS function which is not true. Please amend!
6. In assessment of safety – did you follow any established grading system?
7. Could the manometry assessment be more clearly described or referenced?
8. I assume that a non parametric test is better suited for scale values such as Wexner score etc?
9. The judgement of healing could be more clearly described, i.e. were the assessment of the
fissure based on examination under anesthesia or without. How was it performed?
10. Please define “psychiatric disorder”.
11. Maybe logistic regression is meaningless because of the limited numbers. Proportions are
better.
12. Did you include patients with IBD or did they fall under the exclusion criteria “ non
idiopathic”?
13. Finally, I believe the authors should acknowledge and further stress that the efficacy must
be interpreted in light of the abscence of a control group and that the placebo effect might affect
results.
assistant