Incomplete Ileocecal Bypass for Ileal Pathology in Horses: 21 Cases (2012–2019)
Round 1
Reviewer 1 Report
The study represents a useful contribution to the scientific community of equine cases suffering from surgical disorders of the ileum, treated with an ileocecal bypass. This technique is not original, but large case series are missing in the literature, so a contribution with 21 cases is welcome.
Despite this, the paper must be improved to be accepted.
Particularly, in the materials and methods section, some pivotal points are missing. Criteria adopted for intraoperative selection of patients submitted to the ileocecal bypass must be addressed, and some other parts of the procedure must be detailed as well (as enterotomy performed for ideal content evacuation).
The discussion must consider advantages and possible complications over other methods of treatment, comparing the results of previous studies, as control cases are missing.
Many errors and punctuations omissions must be addressed in the references section.
A revision by an english mother tongue is strongly advised
Comments for author File: 
Comments.pdf
Author Response
We would like to thank the Editor and reviewer for helping us improving our manuscript.
All the comments have been addressed and the whole manuscript has been submitted for proof reading to a professional service (please see attached certificate)
1)Particularly, in the materials and methods section, some pivotal points are missing. Criteria adopted for intraoperative selection of patients submitted to the ileocecal bypass must be addressed,
1) inserted in M&M
2)and some other parts of the procedure must be detailed as well (as enterotomy performed for ideal content evacuation).
2) inserted in M&M
3)The discussion must consider advantages and possible complications over other methods of treatment, comparing the results of previous studies, as control cases are missing.
3) inserted, see text
Author Response File: Author Response.pdf
Reviewer 2 Report
This is a very nice cases series, that I enjoyed reading.
I made a series of language corrections, but the discussion as a whole needs to be re-edited by a professional language editor who is familiar with veterinary terminology. Other than that, the MS is easy to read and nicely written.
The other important thing to edit is to clarify the first surgical technique described, I lost track after alignment of the intestinal track sections.
The drawing and pictures are of excellent quality.
Please edit the following parts:
The language is easy to read, but written like spoken language. “the surgeon may be faced 9with the choice of whether to resect the intestinal tract
Simple summary
Please rephraise this sentence (“could “is not very scientific way to formulate a hypothesis)
”This latter technique could represent a valid alternative to extensive manipulation and it could reduce the recurrence of ileal occlusion and post-operative complication.”
Abstract
If short term survival is 93%, how can 12-month survival be 95%? Please clarify.
There is not really evidence to say “may reduce”, since there is nothing to compare to. Rephraise to “without subsequent” or something similar.
Introduction
Replace “colic” with “cases of colic” or something similar.
Line 40: in stead of “ the surgeon” use passive tense
Line 45: replace burden with infestation
Line 46: replace “our country” with the name of your country
Line 52: complication rate
M&M
Line 66: were these all complications that occurred or only ones, that were included in the study? Laminitis? Post-op fever etc?
Line 72: in which
Line 73: decision of
Line 75: lowercase benzylpenicillin, IU/kg, how much before the preoperative medication was given (range)?
Line 76: calcium gluconate is not universally used, please add indication
Line 77: Anaesthesia was induced with…
Line 78: …isoflurane in X% oxygen. (remove intubation remark)
Line 79: add dexamethasone route of administration, remove “just”.
Line 81: drape (not towel), remove “the”
Line 82: is->was
Line 88 confusing, what is distal part of the proximal third? Ileum? Picture is excellent, try to make the description super clear.
Figure 3: realized?
Line 112: please add suture material
Results
Line 116: stallions? Place in the order of frequency
Line 119: remove decimals
Line 124, remove decimals from PCV, TP7.2 +/-1.1, add unit
Note here, that previously commas were used and now dots, please unify the use of markings to journal style
Line 125: usually these are easier to read eg. “The mean amount of reflux was 0.4 litres (range 0–4 litres).”
Line 131: Do you mean, that in all cases the ileum was viable, but thickened and edematous?
Line 132: remove decimals
Line 132-133: poor language, please rewrite the centence and add mean.
Line 136 With
Line 140: If you have a culture result, please add it here
Line 146: functional might be a wrong choice of words here, since it is a postmortem finding
Line 148: Did any of the horses have hernias?
Line 158: Stubborn :)
Line 166: “Fecal test for Anoplocephala perfoliata was positive in 50% of the cases of ileal impaction reported in our study.” Please check journal guidelines, but usually latin names are written in italic font.
Line 167: dysfunction, relate? Please rephraise the whole sentence
Line 169: preferred->recommended, re-impaction->recurring impaction
Language check is needed.
Author Response
We would like to thank the Editor and reviewer for helping us improving our manuscript.
All the comments have been addressed and the whole manuscript has been submitted for proof reading to a professional service (please see attached certificate)
R1
1)Particularly, in the materials and methods section, some pivotal points are missing. Criteria adopted for intraoperative selection of patients submitted to the ileocecal bypass must be addressed,
1) inserted in M&M
2)and some other parts of the procedure must be detailed as well (as enterotomy performed for ideal content evacuation).
2) inserted in M&M
3)The discussion must consider advantages and possible complications over other methods of treatment, comparing the results of previous studies, as control cases are missing.
3) inserted, see text
Rev 2
1)The other important thing to edit is to clarify the first surgical technique described, I lost track after alignment of the intestinal track sections.
1) the description has been improved
Simple summary
2)Please rephraise this sentence (“could “is not very scientific way to formulate a hypothesis)”This latter technique could represent a valid alternative to extensive manipulation and it could reduce the recurrence of ileal occlusion and post-operative complication.”
2) changed, see text
Abstract
3)If short term survival is 93%, how can 12-month survival be 95%? Please clarify.
3) the reviewer is right. The meaning was that 95% of discharged horses survived.changed, see text
4)There is not really evidence to say “may reduce”, since there is nothing to compare to. Rephraise to “without subsequent” or something similar.
4) changed, see text
Introduction
5)Replace “colic” with “cases of colic” or something similar.
5) changed, see text
6)Line 40: in stead of “ the surgeon” use passive tense
6)Changed, see text
7)Line 45: replace burden with infestation
7) changed, see text
8)Line 46: replace “our country” with the name of your country
8) changed, see text
9) Line 52: complication rate
M&M
10) Line 66: were these all complications that occurred or only ones, that were included in the study? Laminitis? Post-op fever etc?
10) the reviewer is right. We added “fever”. We included only complications that could be related to the presence of the anastomosis
11) Line 72: in which
11) changed, see text
12) Line 73: decision of
12) changed, see text
13) Line 75: lowercase benzylpenicillin, IU/kg, how much before the preoperative medication was given (range)?
13) changed, see text
14) Line 76: calcium gluconate is not universally used, please add indication
14) inserted, see text
15)Line 77: Anaesthesia was induced with…
15) changed, see text
16)Line 78: …isoflurane in X% oxygen. (remove intubation remark)
16) changed, see text
17) Line 79: add dexamethasone route of administration, remove “just”.
17) changed, see text
18)Line 81: drape (not towel), remove “the”
18)changed, see text
19) Line 82: is->was
19)changed, see text
20) Line 88 confusing, what is distal part of the proximal third? Ileum? Picture is excellent, try to make the description super clear.
20) changed, see text
21)Figure 3: realized?
21) changed, see text
22)Line 112: please add suture material
22) changed, see text
Results
23)Line 116: stallions? Place in the order of frequency
23) changed, see text
24)Line 119: remove decimals
24) changed, see text
25)Line 124, remove decimals from PCV, TP7.2 +/-1.1, add unit
Note here, that previously commas were used and now dots, please unify the use of markings to journal style
25) changed, see text
26)Line 125: usually these are easier to read eg. “The mean amount of reflux was 0.4 litres (range 0–4 litres).”
26) changed, see text
27)Line 131: Do you mean, that in all cases the ileum was viable, but thickened and edematous?
27) changed, see text
28)Line 132: remove decimals
28) changed, see text
29)Line 132-133: poor language, please rewrite the centence and add mean.
29the manuscript has been proof-read by an editing service
30)Line 136 With
30) changed, see text
31)Line 140: If you have a culture result, please add it here
31) sorry, we didn’t took a swab on these cases
32)Line 146: functional might be a wrong choice of words here, since it is a postmortem finding
32)changed, see text
33)Line 148: Did any of the horses have hernias?
34) no
35)Line 158: Stubborn :)
35) changed, see text
36)Line 166: “Fecal test for Anoplocephala perfoliata was positive in 50% of the cases of ileal impaction reported in our study.” Please check journal guidelines, but usually latin names are written in italic font.
36) changed, see text
37)Line 167: dysfunction, relate? Please rephraise the whole sentence
37) changed, see text
38)Line 169: preferred->recommended, re-impaction->recurring impaction
38) changed, see text
Rev. 3
Abstract
1)Methods: additional detail on how the selected cases were analysed would be beneficial to include
1)Inserted, see text
Introduction
2)Line 34: please amend to most colics and only a small percentage require
2) changed, see text
3)Line 36: not a new paragraph here, continue from previous sentence
3)changed, see text
4)Line 36: as a multispecies journal, suggesting adding ‘in the horse’ here
4) added, see text
5)Line 38: a brief outline of what the hypothetical explanations are would be beneficial
5) inserted, see text
6)Line 38: please remove while – not required
6)changed, see text
7)Line 52: please amend to complication
7) changed, see text
8) changed, see text
8)Line 56: I would present in past tense as your study is complete
Materials and Methods
9)I appreciate this is a case study review but your method should integrate a data analysis section outlining criteria for how you reviewed the cases and who conducted this to facilitate repetition of your approach.
9) inserted in M &M
10)Line 62-63: please provide abbreviations in full as 1st use in manuscript and not all readers may be familiar with these terms
10) changed, see text
11)Line 81: please amend to towels to avoid contamination – would consider replacing towels with surgical drapes?
11) changed, see text
12)Line 82: present in past tense, was rather than is – apply to description of surgery lines 87 to 113
12) changed, see text
Results
13)Again clearly presented, would be beneficial to present data as absolute values and also relative percentages to illustrate frequency in this sample and facilitate comparison to future studies
14) inserted, see text
14)Line 118: suggest amending to n=xx for number of cases in each breed
14) changed, see text
15)Line 123: suggest rephrasing to The average duration of abdominal presentation before admission was 12 hours (range 6-48 hours).
15) changed, see text
16)Line 124L add units to HR and TP
16) changed, see text
17)Line 125: final sentence is a little unclear, please edit to increase clarity
17) changed, see text
18) Line 125, 131: please double check your present figures as XX.X not XX,X
18) changed, see text
19)Line 133: suggest amending to were bypassed
19) changed, see text
20)Line 136: with spelt incorrectly
20) changed, see text
21)Line 141: seems little odd to present median here when using mean elsewhere
22) changed, see text
Discussion and conclusions
Line 177: insert the before ileum
Reviewer 3 Report
REVIEW Animals Incomplete ileocecal bypass for ileal pathology in horses
An interesting case study review related to equine colic which will be of interest and contribute to this field.
Simple summary
Nice summary provided; scope to simplify for non-veterinary readers who may not be familiar all terms included but recognise that given the subject matter reducing the veterinary terminology is challenging. Would be good to conclude with a summary sentence of what your findings suggest.
Line 9: would remove The as not needed in this sentence
Abstract
Clear summary and I like the use of headings to give the abstract increased structure
Methods: additional detail on how the selected cases were analysed would be beneficial to include
Introduction
Concise but relevant introduction to the topic which establishes a clear rationale for this study
Line 34: please amend to most colics and only a small percentage require
Line 36: not a new paragraph here, continue from previous sentence
Line 36: as a multispecies journal, suggesting adding ‘in the horse’ here
Line 38: a brief outline of what the hypothetical explanations are would be beneficial
Line 38: please remove while – not required
Line 52: please amend to complication
Line 56: I would present in past tense as your study is complete
Materials and Methods
Detailed explanation of selection of case and surgery presented. I appreciate this is a case study review but your method should integrate a data analysis section outlining criteria for how you reviewed the cases and who conducted this to facilitate repetition of your approach.
Line 62-63: please provide abbreviations in full as 1st use in manuscript and not all readers may be familiar with these terms
Line 81: please amend to towels to avoid contamination – would consider replacing towels with surgical drapes?
Line 82: present in past tense, was rather than is – apply to description of surgery lines 87 to 113
Results
Again clearly presented, would be beneficial to present data as absolute values and also relative percentages to illustrate frequency in this sample and facilitate comparison to future studies
Line 118: suggest amending to n=xx for number of cases in each breed
Line 123: suggest rephrasing to The average duration of abdominal presentation before admission was 12 hours (range 6-48 hours).
Line 124L add units to HR and TP
Line 125: final sentence is a little unclear, please edit to increase clarity
Line 125, 131: please double check your present figures as XX.X not XX,X
Line 133: suggest amending to were bypassed
Line 136: with spelt incorrectly
Line 141: seems little odd to present median here when using mean elsewhere
Discussion and conclusions
Relevant discussion and conclusions of the approaches taken and study limitations presented
Line 177: insert the before ileum
Author Response
We would like to thank the Editor and reviewer for helping us improving our manuscript.
All the comments have been addressed and the whole manuscript has been submitted for proof reading to a professional service (please see attached certificate)
R1
1)Particularly, in the materials and methods section, some pivotal points are missing. Criteria adopted for intraoperative selection of patients submitted to the ileocecal bypass must be addressed,
1) inserted in M&M
2)and some other parts of the procedure must be detailed as well (as enterotomy performed for ideal content evacuation).
2) inserted in M&M
3)The discussion must consider advantages and possible complications over other methods of treatment, comparing the results of previous studies, as control cases are missing.
3) inserted, see text
Rev 2
1)The other important thing to edit is to clarify the first surgical technique described, I lost track after alignment of the intestinal track sections.
1) the description has been improved
Simple summary
2)Please rephraise this sentence (“could “is not very scientific way to formulate a hypothesis)”This latter technique could represent a valid alternative to extensive manipulation and it could reduce the recurrence of ileal occlusion and post-operative complication.”
2) changed, see text
Abstract
3)If short term survival is 93%, how can 12-month survival be 95%? Please clarify.
3) the reviewer is right. The meaning was that 95% of discharged horses survived.changed, see text
4)There is not really evidence to say “may reduce”, since there is nothing to compare to. Rephraise to “without subsequent” or something similar.
4) changed, see text
Introduction
5)Replace “colic” with “cases of colic” or something similar.
5) changed, see text
6)Line 40: in stead of “ the surgeon” use passive tense
6)Changed, see text
7)Line 45: replace burden with infestation
7) changed, see text
8)Line 46: replace “our country” with the name of your country
8) changed, see text
9) Line 52: complication rate
M&M
10) Line 66: were these all complications that occurred or only ones, that were included in the study? Laminitis? Post-op fever etc?
10) the reviewer is right. We added “fever”. We included only complications that could be related to the presence of the anastomosis
11) Line 72: in which
11) changed, see text
12) Line 73: decision of
12) changed, see text
13) Line 75: lowercase benzylpenicillin, IU/kg, how much before the preoperative medication was given (range)?
13) changed, see text
14) Line 76: calcium gluconate is not universally used, please add indication
14) inserted, see text
15)Line 77: Anaesthesia was induced with…
15) changed, see text
16)Line 78: …isoflurane in X% oxygen. (remove intubation remark)
16) changed, see text
17) Line 79: add dexamethasone route of administration, remove “just”.
17) changed, see text
18)Line 81: drape (not towel), remove “the”
18)changed, see text
19) Line 82: is->was
19)changed, see text
20) Line 88 confusing, what is distal part of the proximal third? Ileum? Picture is excellent, try to make the description super clear.
20) changed, see text
21)Figure 3: realized?
21) changed, see text
22)Line 112: please add suture material
22) changed, see text
Results
23)Line 116: stallions? Place in the order of frequency
23) changed, see text
24)Line 119: remove decimals
24) changed, see text
25)Line 124, remove decimals from PCV, TP7.2 +/-1.1, add unit
Note here, that previously commas were used and now dots, please unify the use of markings to journal style
25) changed, see text
26)Line 125: usually these are easier to read eg. “The mean amount of reflux was 0.4 litres (range 0–4 litres).”
26) changed, see text
27)Line 131: Do you mean, that in all cases the ileum was viable, but thickened and edematous?
27) changed, see text
28)Line 132: remove decimals
28) changed, see text
29)Line 132-133: poor language, please rewrite the centence and add mean.
29the manuscript has been proof-read by an editing service
30)Line 136 With
30) changed, see text
31)Line 140: If you have a culture result, please add it here
31) sorry, we didn’t took a swab on these cases
32)Line 146: functional might be a wrong choice of words here, since it is a postmortem finding
32)changed, see text
33)Line 148: Did any of the horses have hernias?
34) no
35)Line 158: Stubborn :)
35) changed, see text
36)Line 166: “Fecal test for Anoplocephala perfoliata was positive in 50% of the cases of ileal impaction reported in our study.” Please check journal guidelines, but usually latin names are written in italic font.
36) changed, see text
37)Line 167: dysfunction, relate? Please rephraise the whole sentence
37) changed, see text
38)Line 169: preferred->recommended, re-impaction->recurring impaction
38) changed, see text
Rev. 3
Abstract
1)Methods: additional detail on how the selected cases were analysed would be beneficial to include
1)Inserted, see text
Introduction
2)Line 34: please amend to most colics and only a small percentage require
2) changed, see text
3)Line 36: not a new paragraph here, continue from previous sentence
3)changed, see text
4)Line 36: as a multispecies journal, suggesting adding ‘in the horse’ here
4) added, see text
5)Line 38: a brief outline of what the hypothetical explanations are would be beneficial
5) inserted, see text
6)Line 38: please remove while – not required
6)changed, see text
7)Line 52: please amend to complication
7) changed, see text
8) changed, see text
8)Line 56: I would present in past tense as your study is complete
Materials and Methods
9)I appreciate this is a case study review but your method should integrate a data analysis section outlining criteria for how you reviewed the cases and who conducted this to facilitate repetition of your approach.
9) inserted in M &M
10)Line 62-63: please provide abbreviations in full as 1st use in manuscript and not all readers may be familiar with these terms
10) changed, see text
11)Line 81: please amend to towels to avoid contamination – would consider replacing towels with surgical drapes?
11) changed, see text
12)Line 82: present in past tense, was rather than is – apply to description of surgery lines 87 to 113
12) changed, see text
Results
13)Again clearly presented, would be beneficial to present data as absolute values and also relative percentages to illustrate frequency in this sample and facilitate comparison to future studies
13) inserted, see text
14)Line 118: suggest amending to n=xx for number of cases in each breed
14) changed, see text
15)Line 123: suggest rephrasing to The average duration of abdominal presentation before admission was 12 hours (range 6-48 hours).
15) changed, see text
16)Line 124L add units to HR and TP
16) changed, see text
17)Line 125: final sentence is a little unclear, please edit to increase clarity
17) changed, see text
18) Line 125, 131: please double check your present figures as XX.X not XX,X
18) changed, see text
19)Line 133: suggest amending to were bypassed
19) changed, see text
20)Line 136: with spelt incorrectly
20) changed, see text
21)Line 141: seems little odd to present median here when using mean elsewhere
22) changed, see text
Discussion and conclusions
Line 177: insert the before ileum
Round 2
Reviewer 1 Report
The paper is much improved, and can be published in the present form
