Reviewer’s report  
Title: Role of preoperative biliary stents, bile contamination and antibiotic prophylaxis in 
surgical  site infections after  pancreaticoduodenectomy  
 
Version: 0 Date: 08 Dec 2015  
 
Reviewer: A Cho  
Reviewer’s report:  
Authors retrospectively reviewed 180 patients undergoing PD, and compared stented and non -
stented groups to assess any differences in post -operative morbidity and mortality.  
Although similar retrospective, non -randomized studies have been already reported, it is 
interesting that biliary stenting was confirmed as a risk factor for deep incisional SSIs in 
multiva riate analysis.  
 
The manuscript is clear and well presented; however,  
Authors are desired to address following points.  
 
1. All 89 patients in the stented group had obstructive jaundice, while only 13 of 91 patients 
in the non -stented group. Although the n umber is small, authors should compare stented 
and non -stented patients with obstructive jaundice.  
 
2. How many patients underwent pre -operative ERCP in the non -stented group? Were any 
differences observed between patients with or without ERCP?  
 
3. Authors d escribed that the longer the biliary stent is in place, the longer the reflux of 
intestinal bacteria into the biliary tree and thus the risk of bacterial colonization in 
Discussion. How was bacterial contamination of bile in six patient undergoing PTBD? If  
the low percentage, PTBD should be recommended for patients with relatively long 
waiting times before surgery.  
 
4. There are a few spelling mistakes, "abserve"in Discussion (Page 14, Line 1).  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which con trols 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 manuscript or would you r ecommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please in dicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, consideri ng the following questions:  
 
1. Have you in the past five years received reimbursements, fees, fun ding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, e ither now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from t he publication of this manuscript, e ither 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 of the manuscript?  
 
5. Do you have any other fin ancial 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.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on m y report to the authors and, if the manuscript is accepted for 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 wish to be included in my named report can be included 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: Role of preoperative biliary stents, bile contamination and antibiotic prophylaxis in 
surgical  site infections after  pancreaticoduodenectomy  
 
Version: 0 Date: 08 Dec 2015  
 
Reviewer: A Cho  
Reviewer’s report:  
Authors retrospectively reviewed 180 patients undergoing PD, and compared stented and non -
stented groups to assess any differences in post -operative morbidity and mortality.  
Although similar retrospective, non -randomized studies have been already reported, it is 
interesting that biliary stenting was confirmed as a risk factor for deep incisional SSIs in 
multiva riate analysis.  
 
The manuscript is clear and well presented; however,  
Authors are desired to address following points.  
 
1. All 89 patients in the stented group had obstructive jaundice, while only 13 of 91 patients 
in the non -stented group. Although the n umber is small, authors should compare stented 
and non -stented patients with obstructive jaundice.  
 
2. How many patients underwent pre -operative ERCP in the non -stented group? Were any 
differences observed between patients with or without ERCP?  
 
3. Authors d escribed that the longer the biliary stent is in place, the longer the reflux of 
intestinal bacteria into the biliary tree and thus the risk of bacterial colonization in 
Discussion. How was bacterial contamination of bile in six patient undergoing PTBD? If  
the low percentage, PTBD should be recommended for patients with relatively long 
waiting times before surgery.  
 
4. There are a few spelling mistakes, "abserve"in Discussion (Page 14, Line 1).  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which con trols 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 manuscript or would you r ecommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please in dicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, consideri ng the following questions:  
 
1. Have you in the past five years received reimbursements, fees, fun ding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, e ither now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from t he publication of this manuscript, e ither 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 of the manuscript?  
 
5. Do you have any other fin ancial 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.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on m y report to the authors and, if the manuscript is accepted for 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 wish to be included in my named report can be included 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: Role of preoperative biliary stents, bile contamination and antibiotic prophylaxis in 
surgical  site infections after  pancreaticoduodenectomy  
 
Version: 0 Date: 08 Dec 2015  
 
Reviewer: A Cho  
Reviewer’s report:  
Authors retrospectively reviewed 180 patients undergoing PD, and compared stented and non -
stented groups to assess any differences in post -operative morbidity and mortality.  
Although similar retrospective, non -randomized studies have been already reported, it is 
interesting that biliary stenting was confirmed as a risk factor for deep incisional SSIs in 
multiva riate analysis.  
 
The manuscript is clear and well presented; however,  
Authors are desired to address following points.  
 
1. All 89 patients in the stented group had obstructive jaundice, while only 13 of 91 patients 
in the non -stented group. Although the n umber is small, authors should compare stented 
and non -stented patients with obstructive jaundice.  
 
2. How many patients underwent pre -operative ERCP in the non -stented group? Were any 
differences observed between patients with or without ERCP?  
 
3. Authors d escribed that the longer the biliary stent is in place, the longer the reflux of 
intestinal bacteria into the biliary tree and thus the risk of bacterial colonization in 
Discussion. How was bacterial contamination of bile in six patient undergoing PTBD? If  
the low percentage, PTBD should be recommended for patients with relatively long 
waiting times before surgery.  
 
4. There are a few spelling mistakes, "abserve"in Discussion (Page 14, Line 1).  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which con trols 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 manuscript or would you r ecommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please in dicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, consideri ng the following questions:  
 
1. Have you in the past five years received reimbursements, fees, fun ding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, e ither now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from t he publication of this manuscript, e ither 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 of the manuscript?  
 
5. Do you have any other fin ancial 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.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on m y report to the authors and, if the manuscript is accepted for 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 wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant