Reviewer ’s report  
Title: Optimal timing of cholecystectomy after percutaneous gallbladder drainage for severe  
cholecystitis  
 
Version: 0 Date: 02 Mar 2017  
 
Reviewer: Tomoyuki Abe  
 
Reviewer's report:  
Inoue et al describe d that patients with acute cholecystitis after percutaneous transhepatic 
gallbladder drainage were subdivided into two groups according to the surgical difficulty. They 
analyzed to investigate the optimal surgical timing for patients with severe cholecysti tis and 
concluded that within 216 hours after percutaneous transhepatic gallbladder drainage is was 
feasible and safe.  The previous history of upper gastrointestinal surgery is not obstacle to 
completely perform laparoscopic cholecystectomy, frequently ch anging the 1 -st port position and 
use of energy devise make it easy to complete LC. The patients criteria should be revised.  
 
Major revise  
1. The criteria of the patient enrollment was obscure. Especially patients with un -sucessfully 
treated by PTGBD shou ld be included. These patients should be included into the group A. 
In clinical situation, we encounter these patients and should perform emergency operations. 
These patients could have influenced the surgical outcomes strongly. In addition, the 
patients w ith G3 should be excluded from this study, patients with G3 were previously 
affect negatively morbidity and mortality. These patients can not be divided into two 
groups clearly.   
 
2. Difficulty of quantitative evaluation of cholecystectomy is not appropri ate with less 
objectively. Conversion to open procedures is happened due to the several reasons, such as 
the  attending surgeon's experience, and unexpected intraoperative bleeding and biliary 
injury.   
 
3. In discussion part, authors demonstrated that PTG BD is safe and effective treatment with 
low mortality rates. However, as you mentioned in the patients selection, the success rates 
of PTGBD is not enough as previous reports. Please explain the discrepancy of your data 
and previous reports in regard to th e efficacy of PTGBD. Also, you should include patients 
in your study who underwent PTGBD whether successfully performed or not.  
 
4. In discussion part on pg12, you stated that proper selection of patients is important for safe 
performance of early PC follo wing PTGBD. Please describe more  clearly and concretely.  
 
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 controls are required in your comments to the authors.  
Yes 
Are the conclusions drawn adequately supporte d by the data shown?  
If not, please explain in your comments to the authors.  
No 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please spec ify what aspects require further  
assessment in your comments to the editors.  
I recommend additional statistical review  
Quality of written English  
Please indicate the quality of language in the manuscript:  
Needs some language corrections before being published  
Declaration of competing interests  
Please comple te a declaration of competing interests, considering the following questions:  
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of thi s 
manuscript, either 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 the publication of this manuscript, either now or in the future?  
3. Do you hold or are you currently applyin g 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 financ ial 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.  
 
There is no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for pub lication, 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/license s/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: Optimal timing of cholecystectomy after percutaneous gallbladder drainage for severe  
cholecystitis  
 
Version: 0 Date: 02 Mar 2017  
 
Reviewer: Tomoyuki Abe  
 
Reviewer's report:  
Inoue et al describe d that patients with acute cholecystitis after percutaneous transhepatic 
gallbladder drainage were subdivided into two groups according to the surgical difficulty. They 
analyzed to investigate the optimal surgical timing for patients with severe cholecysti tis and 
concluded that within 216 hours after percutaneous transhepatic gallbladder drainage is was 
feasible and safe.  The previous history of upper gastrointestinal surgery is not obstacle to 
completely perform laparoscopic cholecystectomy, frequently ch anging the 1 -st port position and 
use of energy devise make it easy to complete LC. The patients criteria should be revised.  
 
Major revise  
1. The criteria of the patient enrollment was obscure. Especially patients with un -sucessfully 
treated by PTGBD shou ld be included. These patients should be included into the group A. 
In clinical situation, we encounter these patients and should perform emergency operations. 
These patients could have influenced the surgical outcomes strongly. In addition, the 
patients w ith G3 should be excluded from this study, patients with G3 were previously 
affect negatively morbidity and mortality. These patients can not be divided into two 
groups clearly.   
 
2. Difficulty of quantitative evaluation of cholecystectomy is not appropri ate with less 
objectively. Conversion to open procedures is happened due to the several reasons, such as 
the  attending surgeon's experience, and unexpected intraoperative bleeding and biliary 
injury.   
 
3. In discussion part, authors demonstrated that PTG BD is safe and effective treatment with 
low mortality rates. However, as you mentioned in the patients selection, the success rates 
of PTGBD is not enough as previous reports. Please explain the discrepancy of your data 
and previous reports in regard to th e efficacy of PTGBD. Also, you should include patients 
in your study who underwent PTGBD whether successfully performed or not.  
 
4. In discussion part on pg12, you stated that proper selection of patients is important for safe 
performance of early PC follo wing PTGBD. Please describe more  clearly and concretely.  
 
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 controls are required in your comments to the authors.  
Yes 
Are the conclusions drawn adequately supporte d by the data shown?  
If not, please explain in your comments to the authors.  
No 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please spec ify what aspects require further  
assessment in your comments to the editors.  
I recommend additional statistical review  
Quality of written English  
Please indicate the quality of language in the manuscript:  
Needs some language corrections before being published  
Declaration of competing interests  
Please comple te a declaration of competing interests, considering the following questions:  
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of thi s 
manuscript, either 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 the publication of this manuscript, either now or in the future?  
3. Do you hold or are you currently applyin g 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 financ ial 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.  
 
There is no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for pub lication, 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/license s/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: Optimal timing of cholecystectomy after percutaneous gallbladder drainage for severe  
cholecystitis  
 
Version: 0 Date: 02 Mar 2017  
 
Reviewer: Tomoyuki Abe  
 
Reviewer's report:  
Inoue et al describe d that patients with acute cholecystitis after percutaneous transhepatic 
gallbladder drainage were subdivided into two groups according to the surgical difficulty. They 
analyzed to investigate the optimal surgical timing for patients with severe cholecysti tis and 
concluded that within 216 hours after percutaneous transhepatic gallbladder drainage is was 
feasible and safe.  The previous history of upper gastrointestinal surgery is not obstacle to 
completely perform laparoscopic cholecystectomy, frequently ch anging the 1 -st port position and 
use of energy devise make it easy to complete LC. The patients criteria should be revised.  
 
Major revise  
1. The criteria of the patient enrollment was obscure. Especially patients with un -sucessfully 
treated by PTGBD shou ld be included. These patients should be included into the group A. 
In clinical situation, we encounter these patients and should perform emergency operations. 
These patients could have influenced the surgical outcomes strongly. In addition, the 
patients w ith G3 should be excluded from this study, patients with G3 were previously 
affect negatively morbidity and mortality. These patients can not be divided into two 
groups clearly.   
 
2. Difficulty of quantitative evaluation of cholecystectomy is not appropri ate with less 
objectively. Conversion to open procedures is happened due to the several reasons, such as 
the  attending surgeon's experience, and unexpected intraoperative bleeding and biliary 
injury.   
 
3. In discussion part, authors demonstrated that PTG BD is safe and effective treatment with 
low mortality rates. However, as you mentioned in the patients selection, the success rates 
of PTGBD is not enough as previous reports. Please explain the discrepancy of your data 
and previous reports in regard to th e efficacy of PTGBD. Also, you should include patients 
in your study who underwent PTGBD whether successfully performed or not.  
 
4. In discussion part on pg12, you stated that proper selection of patients is important for safe 
performance of early PC follo wing PTGBD. Please describe more  clearly and concretely.  
 
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 controls are required in your comments to the authors.  
Yes 
Are the conclusions drawn adequately supporte d by the data shown?  
If not, please explain in your comments to the authors.  
No 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please spec ify what aspects require further  
assessment in your comments to the editors.  
I recommend additional statistical review  
Quality of written English  
Please indicate the quality of language in the manuscript:  
Needs some language corrections before being published  
Declaration of competing interests  
Please comple te a declaration of competing interests, considering the following questions:  
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of thi s 
manuscript, either 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 the publication of this manuscript, either now or in the future?  
3. Do you hold or are you currently applyin g 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 financ ial 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.  
 
There is no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for pub lication, 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/license s/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