Submited on: 08 May 2012 08:59:22 AM GMT
Published on: 08 May 2012 07:37:49 PM GMT
 
Dr. Peter J. DiPasco
Posted by Anonymous Reviewer on 11 Jun 2012 11:20:42 PM GMT

  • What are the main claims of the paper and how important are they?

    That CT imaging can indentify the anatomic reason for failed left colon anastomoses- vascular insufficiency.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    Somewhat novel in that I am not aware that anyone has looked for de facto evidence of vascular failure as the cause of a anastomotic dehiscence, but then again this is always one of the indicted culprits.


  • Are the claims properly placed in the context of the previous literature?

    Yes.


  • Do the results support the claims? If not, what other evidence is required?

    They provide images and explanations of the paucity of vascular supply to the areas of dehisced anastomoses, but I feel with CT imaging there is a large question of the timing of contrast bolusing vis a vis the vasculature outlined.


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    Not applicable.


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    Yes. Simple to reproduce.


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    I do not see an area for improvement with this study, unless proof can be provided that by identifying rosl factors by using this approach offers an improvement in outcomes for the patient such as decreased hospital stay or decreased post-operative abscesses for instance. It is otherwise of little clincal usefulness.


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    No, I do not feel so. If anything, the radiographic evidence of a vascular cause for an anastomotic dehiscence does not change the management of the patient or stratify patients to high or low risk groups when it matters-- before the anastomosis is created. Demonstrating this finding post-operatively is of little clinical use. Taking this a step further, it would be unreasonable to extrapolate the theory of this paper to propose pre-operative colonic vascular imaging as a way to guide anastomotic placement as the cost alone would be steeply prohibitive for the thousands of colectomies performed in this country alone.


  • Other Comments:

    Occasional spelling errors. Some lapses in syntax; a english as a primary language editor should be ultilized prior to submission.

  • Competing interests:
    No.
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    No
  • References:
  • Experience and credentials in the specific area of science:
    I am a General Surgeon and Surgical Oncologist
  • How to cite:  Anonymous.Dr. Peter J. DiPasco[Review of the article 'Vascular Risk Factors in Left Colon Anastomosis Leakage: A Computed Tomography Guided Study ' by Donatiello S].WebmedCentral 2012;3(6):WMCRW001908
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  • What are the main claims of the paper and how important are they?

    Vascular insufficiency is a known factor for anastomotivc leak


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    Yes


  • Are the claims properly placed in the context of the previous literature?

    No


  • Do the results support the claims? If not, what other evidence is required?

    No.a randomised controlled study


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    No


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    Poor


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    I think authors need to work more before publishing this paper.in fact you need to have a randomissed controlled study before a safe conclusion is drawn that will also avoid the discrepancy in patient factors.like if the hb level of all patients would be same ,conclusion would be more accurate.the manuscript should be precisely written taking care to maintain the idea behind the study and also a special care needs to be taken to maintain the grammar of the essay and avoid technical mistakes.i would recommend authors to have a study of not less than 50 patients before the conclusion is drawn.

    thanks


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    No


  • Other Comments:

    Some more work is required

  • Competing interests:
    Nil
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    No
  • References:

    No

  • Experience and credentials in the specific area of science:

    Average

  • How to cite:  Chalkoo M .Vascular Risk Factors in Left Colon Anastomosis Leakage: A Computed Tomography Guided Study[Review of the article 'Vascular Risk Factors in Left Colon Anastomosis Leakage: A Computed Tomography Guided Study ' by Donatiello S].WebmedCentral 2012;3(6):WMCRW001881
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  • What are the main claims of the paper and how important are they?

    Ischemia of the colon segments is an important pathogenetic factor in anastomotc leakage. It can be detected by CT.

    Adequate vascularity is most important factor for anastamotic healing .It is more important to diagnose potential ischemia preop or intraop as it helps in planning surgery


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    No 

    Adequate vascularity is universal  for any healing


  • Are the claims properly placed in the context of the previous literature?

    yes


  • Do the results support the claims? If not, what other evidence is required?

    Yes 

    Intra op findings and histology of colonic end if availablle  would substantiate the claim.


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    NA


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    YES


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    Intra op findings like cyanosis,congestion,bleeding edges,doppler

    Histology of colonic end

    Some of the above will  not be available in all cases.


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    No

    Is presentable because of the data accumulated on an important problem


  • Other Comments:

    NIL

  • Competing interests:
    NIL
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    Frequently encounter anastamotic problem

  • How to cite:  Thakur R .Vascular Risk Factors in Left Colon Anastomosis Leakage: A Computed Tomography Guided Study[Review of the article 'Vascular Risk Factors in Left Colon Anastomosis Leakage: A Computed Tomography Guided Study ' by Donatiello S].WebmedCentral 2012;3(6):WMCRW001874
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vascular risk factors in left colon anastomosis leakage: a computed tomography guided study
Posted by Anonymous Reviewer on 05 Jun 2012 05:25:16 PM GMT

  • What are the main claims of the paper and how important are they?

    identification of vascular risk factors in left colon anastomosis leakage & use of CT guided study for this.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    yes


  • Are the claims properly placed in the context of the previous literature?

    not really.


  • Do the results support the claims? If not, what other evidence is required?

    not satisfactorily as the study lacks basic study pattern & methods used. 


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    NA


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    not very satisfactory.


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    yes like use of ct angiography & its comparison with vascular doppler study to reveal pattern & level of ischemia.


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    no


  • Other Comments:

    this paper needs revision & resubmission with use of tables, statistical backup & comparison with other vascular study methodology. it needs basically a clear understanding of the use of this approach everywhere. itis not clear what exactly the author wants to send  message & its overall usefullness for colonic anastomosis.

  • Competing interests:
    0
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    being a gastrointestinal & colo-rectal surgeon it is very important to me the assessment of vascularity for any anastomosis specially left colonic one. clinical on table judgement is the best what i feel. CT can be very useful too but it can not tell about pattern of suturing incorporated by a particular surgeon which is very important factor for leak.

  • How to cite:  Anonymous.vascular risk factors in left colon anastomosis leakage: a computed tomography guided study[Review of the article 'Vascular Risk Factors in Left Colon Anastomosis Leakage: A Computed Tomography Guided Study ' by Donatiello S].WebmedCentral 2012;3(6):WMCRW001873
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Vascular risk factors in left colon anastomosis
Posted by Anonymous Reviewer on 05 Jun 2012 01:13:19 PM GMT

  • What are the main claims of the paper and how important are they?

    It appears rather unclear if the main objective of the study is the attempt of identifying risk factors that are indeed amenable to preventive measures. If not the title of the manuscript should be changed into "CT demonstration of vascular alterations in cases with anastomotic leackage"


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    The main claim is certainly not novel, even if a CT demonstration of the vascular alterations leading or accompanying an anastomotic leakage or disruption represent a quite recent and somewhat original contribution


  • Are the claims properly placed in the context of the previous literature?

    Yes they are


  • Do the results support the claims? If not, what other evidence is required?

    What is absolutely needed in order to elevate the level of significance of this study, is examining by CT a series of patients who received the same surgical treatment, comparing the results of the vascular imaging in cases with no complications, cases with delayed bowel movement or painful abdomen and finally in complicated cases with clinical or subclinical evidence of an anastomotic leak. Uni / multi-variate analysis will then demonstrate vascular alterations that are certainly linked with an anastomotic failure.

    Moreover a protocol should be provided in order to clearly separate those vascular alteration that are consequent to a localized or diffuse peritonitis, from those which are major determinants of an anastomotic complication.

     


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    A protocol should be provided.

    Otherwise the paper should change its declared focus, starting from a change of its title.


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    Yes it is, with some objections that were already made in the previous paragraphs


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    Yes (see above)

    Extra work sounds to be not overwhelming


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    Even after review and a new study ptotocol, due to its main objective, this interesting study will not reach the level of an "outstanding" contribution.


  • Other Comments:

    NA

  • Competing interests:
    NA
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    No
  • References:
  • Experience and credentials in the specific area of science:
    >400 colon resections yearly
  • How to cite:  Anonymous.Vascular risk factors in left colon anastomosis[Review of the article 'Vascular Risk Factors in Left Colon Anastomosis Leakage: A Computed Tomography Guided Study ' by Donatiello S].WebmedCentral 2012;3(6):WMCRW001872
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CT evaluation of left colonic anastomosis
Posted by Anonymous Reviewer on 05 Jun 2012 05:54:28 AM GMT

  • What are the main claims of the paper and how important are they?

    CT evaluation of Vascular supply in the face of leaked colonic anastomosis

     

    In a post operative patient following colonic surgery it is relevant.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    No


  • Are the claims properly placed in the context of the previous literature?

    yes


  • Do the results support the claims? If not, what other evidence is required?

    NA


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    NA


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    yes


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    tabulation of results in a more elaborate manner would help to appreciate the results better


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    Ability to predict leak would be a crucial piece of information for the surgeon. If the study is focussed on the same it would enhance the utility of the study.


  • Other Comments:

    NA

  • Competing interests:
    no
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    NA

  • How to cite:  Anonymous.CT evaluation of left colonic anastomosis[Review of the article 'Vascular Risk Factors in Left Colon Anastomosis Leakage: A Computed Tomography Guided Study ' by Donatiello S].WebmedCentral 2012;3(6):WMCRW001869
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VAscular risk factors
Posted by Dr. Amit Gupta on 12 May 2012 04:10:38 PM GMT

1 Is the subject of the article within the scope of the subject category? Yes
2 Are the interpretations / conclusions sound and justified by the data? Yes
3 Is this a new and original contribution? Yes
4 Does this paper exemplify an awareness of other research on the topic? Yes
5 Are structure and length satisfactory? No
6 Can you suggest brief additions or amendments or an introductory statement that will increase the value of this paper for an international audience? Yes
7 Can you suggest any reductions in the paper, or deletions of parts? No
8 Is the quality of the diction satisfactory? Yes
9 Are the illustrations and tables necessary and acceptable? Yes
10 Are the references adequate and are they all necessary? Yes
11 Are the keywords and abstract or summary informative? Yes
  • Other Comments:

    Overall a very good study but I fail to understand that in place of CECT abdomen why the author had not focussed on CT Angiography of patient if their motive was to prove vascular factor primarily responsible for anastomotic leak in colon. I disagree with author that mesenteric venous thrombosis is on a decline. All the indexed literature suggest that the incidence of mesenteric ischemia is on rise mainly due to increased cardiovascular problems and life style changes. Discussion could have been more elaborate.

  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    Yes
  • References:
    Chapter on technique of Anastomosis in the book titled "Basic surgical skills" by JP publications
  • Experience and credentials in the specific area of science:

    We are routinely dealing with colonic surgeries in our hospital

  • How to cite:  Gupta A .VAscular risk factors[Review of the article 'Vascular Risk Factors in Left Colon Anastomosis Leakage: A Computed Tomography Guided Study ' by Donatiello S].WebmedCentral 2012;3(5):WMCRW001798
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