Reviewer ’s report  
 
Title: Long -term Outcomes and Quality of Life of Patien ts with Hirschsprung Disease: A 
Systematic Review and Meta -analysis  
 
Version: 2 Date: 19 Aug 2019  
 
Reviewer: Research Square  
 
Reviewer's report:  
 
STATISTICAL REVIEWER ASSESSMENT:  
 
Is the study design appropriate for the resea rch question (considering whether the analyzed 
population accurately reflects the design and whether you see any problems with 
control/comparison groups, e.g., likely confounders)?  
 
Yes - overall design, population, and control groups are appropriate  
 
 
Are m ethodologies adequate and well implemented (considering whether assumptions are 
addressed and whether analyses are robust)?  
 
No - there are minor issues  
 
 
Are the analyses adequately communicated (considering whether reporting details are adequate 
and whethe r figures and tables are well labeled and described)?  
 
Yes - important reporting details are present, analyses are adequately communicated, figures and 
tables are well labeled and described  
 
 
Does the interpretation accurately reflect the analyses without overstatement (considering 
whether limitations/bias are acknowledged and whether accurate descriptors, e.g., 'significant', 
are used?  
 
Yes - interpretation accurately reflects analyses, limitat ions/bias are acknowledged, accurate 
descriptors are used  
 
 
Could an appropriately REVISED version of this work represent a statistically sound 
contribution?  
 
Probably - with minor revisions  
 
STATISTICAL REVIEWER COMMENTS:  
 
The study was well conducted. Sea rch strategy has been well defined and details of search 
strategy has been provided.  However, excluding non -English papers may lead to language bias. 
Relevant articles with useful information that may have been excluded. Appropriate tools were 
used for qu ality assessment of included studies, however, interpretation of quality assessment 
scales has not been provided in the methods section. Heterogeneity is usually classified as low, 
moderate and high. why was a cut -off of 50% chosen for conducting subgroup analysis? Please 
provide full form of BFS scale at first instance. Please provide a description on interpretation of 
BFS scale score. Please provide a description of interpretation of GIQLI scores. Publication bias 
plots can be provided as supplementary ma terial instead of the main text. Limitations of the 
study have been provided. Also, future research direction has been provided.  
 
 
REQUESTED REVISIONS:  
 
Please review above suggestions.  
 
 
ADDITIONAL REQUESTS/SUGGESTIONS:  
 
None.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
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 additiona l 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:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gai n 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 you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content o f the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests 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.  
 
This reviewer has been recruited by a partner organization, Research Square. Reviewers with 
declared or apparent competing interests are not utilized for t hese reviews. Thi s reviewer has 
agreed to pub lication of their comments online under a Creat ive Commons Attribution License 
attributed to Research Square and was paid a small honorarium for  completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of t he reviewer 
recommendation.  
 
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 authors' 
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 wi sh to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Long -term Outcomes and Quality of Life of Patien ts with Hirschsprung Disease: A 
Systematic Review and Meta -analysis  
 
Version: 2 Date: 19 Aug 2019  
 
Reviewer: Research Square  
 
Reviewer's report:  
 
STATISTICAL REVIEWER ASSESSMENT:  
 
Is the study design appropriate for the resea rch question (considering whether the analyzed 
population accurately reflects the design and whether you see any problems with 
control/comparison groups, e.g., likely confounders)?  
 
Yes - overall design, population, and control groups are appropriate  
 
 
Are m ethodologies adequate and well implemented (considering whether assumptions are 
addressed and whether analyses are robust)?  
 
No - there are minor issues  
 
 
Are the analyses adequately communicated (considering whether reporting details are adequate 
and whethe r figures and tables are well labeled and described)?  
 
Yes - important reporting details are present, analyses are adequately communicated, figures and 
tables are well labeled and described  
 
 
Does the interpretation accurately reflect the analyses without overstatement (considering 
whether limitations/bias are acknowledged and whether accurate descriptors, e.g., 'significant', 
are used?  
 
Yes - interpretation accurately reflects analyses, limitat ions/bias are acknowledged, accurate 
descriptors are used  
 
 
Could an appropriately REVISED version of this work represent a statistically sound 
contribution?  
 
Probably - with minor revisions  
 
STATISTICAL REVIEWER COMMENTS:  
 
The study was well conducted. Sea rch strategy has been well defined and details of search 
strategy has been provided.  However, excluding non -English papers may lead to language bias. 
Relevant articles with useful information that may have been excluded. Appropriate tools were 
used for qu ality assessment of included studies, however, interpretation of quality assessment 
scales has not been provided in the methods section. Heterogeneity is usually classified as low, 
moderate and high. why was a cut -off of 50% chosen for conducting subgroup analysis? Please 
provide full form of BFS scale at first instance. Please provide a description on interpretation of 
BFS scale score. Please provide a description of interpretation of GIQLI scores. Publication bias 
plots can be provided as supplementary ma terial instead of the main text. Limitations of the 
study have been provided. Also, future research direction has been provided.  
 
 
REQUESTED REVISIONS:  
 
Please review above suggestions.  
 
 
ADDITIONAL REQUESTS/SUGGESTIONS:  
 
None.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
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 additiona l 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:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gai n 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 you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content o f the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests 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.  
 
This reviewer has been recruited by a partner organization, Research Square. Reviewers with 
declared or apparent competing interests are not utilized for t hese reviews. Thi s reviewer has 
agreed to pub lication of their comments online under a Creat ive Commons Attribution License 
attributed to Research Square and was paid a small honorarium for  completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of t he reviewer 
recommendation.  
 
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 authors' 
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 wi sh to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Long -term Outcomes and Quality of Life of Patien ts with Hirschsprung Disease: A 
Systematic Review and Meta -analysis  
 
Version: 2 Date: 19 Aug 2019  
 
Reviewer: Research Square  
 
Reviewer's report:  
 
STATISTICAL REVIEWER ASSESSMENT:  
 
Is the study design appropriate for the resea rch question (considering whether the analyzed 
population accurately reflects the design and whether you see any problems with 
control/comparison groups, e.g., likely confounders)?  
 
Yes - overall design, population, and control groups are appropriate  
 
 
Are m ethodologies adequate and well implemented (considering whether assumptions are 
addressed and whether analyses are robust)?  
 
No - there are minor issues  
 
 
Are the analyses adequately communicated (considering whether reporting details are adequate 
and whethe r figures and tables are well labeled and described)?  
 
Yes - important reporting details are present, analyses are adequately communicated, figures and 
tables are well labeled and described  
 
 
Does the interpretation accurately reflect the analyses without overstatement (considering 
whether limitations/bias are acknowledged and whether accurate descriptors, e.g., 'significant', 
are used?  
 
Yes - interpretation accurately reflects analyses, limitat ions/bias are acknowledged, accurate 
descriptors are used  
 
 
Could an appropriately REVISED version of this work represent a statistically sound 
contribution?  
 
Probably - with minor revisions  
 
STATISTICAL REVIEWER COMMENTS:  
 
The study was well conducted. Sea rch strategy has been well defined and details of search 
strategy has been provided.  However, excluding non -English papers may lead to language bias. 
Relevant articles with useful information that may have been excluded. Appropriate tools were 
used for qu ality assessment of included studies, however, interpretation of quality assessment 
scales has not been provided in the methods section. Heterogeneity is usually classified as low, 
moderate and high. why was a cut -off of 50% chosen for conducting subgroup analysis? Please 
provide full form of BFS scale at first instance. Please provide a description on interpretation of 
BFS scale score. Please provide a description of interpretation of GIQLI scores. Publication bias 
plots can be provided as supplementary ma terial instead of the main text. Limitations of the 
study have been provided. Also, future research direction has been provided.  
 
 
REQUESTED REVISIONS:  
 
Please review above suggestions.  
 
 
ADDITIONAL REQUESTS/SUGGESTIONS:  
 
None.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
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 additiona l 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:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gai n 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 you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content o f the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests 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.  
 
This reviewer has been recruited by a partner organization, Research Square. Reviewers with 
declared or apparent competing interests are not utilized for t hese reviews. Thi s reviewer has 
agreed to pub lication of their comments online under a Creat ive Commons Attribution License 
attributed to Research Square and was paid a small honorarium for  completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of t he reviewer 
recommendation.  
 
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 authors' 
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 wi sh to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant