Recurrence Rates of Pilonidal Sinus Disease Are High in Children and Recurrences Occur Exceedingly Early
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsAbstract needs to be of structured format.
There are blunt words used in manuscript , try to use impler words.
Could author mention which ty[pe ofv review is it..
Methodology is not clear
you are just collecting data and intepreting data.
The manuscript is not systemically written.
Comments on the Quality of English Language
Editor should asses manuscript first itself whether it deserves review technically
Author Response
Abstract needs to be of structured format.
It may have escaped the reviewer's notice that the opposite is true for this journal. The instructions for authors read for the abstract: "The abstract should be a total of about 200 words maximum. The abstract should be a single paragraph and should follow the style of structured abstracts, but without headings: [...]".
There are blunt words used in manuscript , try to use impler words.
We have reviewed the manuscript accordingly.
Could author mention which ty[pe ofv review is it.
This has been included in the introduction.
Methodology is not clear
This aspect has been amended to the introduction.
you are just collecting data and intepreting data.
This is essentially the idea of a review, as per the instructions to authors a review would "provide concise and precise updates on the latest progress made in a given area of research".
The manuscript is not systemically written.
We disagree on this aspect. Although we have structured the review, this is not a prerequisite of the journal. We may, again, quote the author guidelines: "a literature review organized logically within specific sections and subsections (optional)."
Reviewer 2 Report
Comments and Suggestions for Authors1. I would not mention 'low' recurrence rate for 2% per year - it is very high as pilonidal sinus affects young population. So overall recurrence rate is very high. So stating it is low is actually misleading. - abstract 2nd line and introduction/discussion segment please ensure this is corrected.
2. Logically and by common sense 2.9 months time to recurrence is not due to pathology but by poor or inadequate surgery or surgical skills or training etc. So we should not blame very early recurrence either to child or infant or adult, because it is about technique and not patient.
3. You did not tell how did you search the studies. what was the methodology. which databases did u look at.
4. You did not cover the important issues in children - as the focus is on children - you are expected to discuss school absentism, parental off-duty, medico-legal implications for recurrence, insurance buying or policy exclusions and financial burden etc -- i understand there might not be data, but these are the issues that you are expected to discuss as your focus is on children
5. what about squamous carcinoma development.
6. any role of obesity? any role of smoking and is this the reasons for recurrence
7. is the recurrence solely due to better care by parents so they check and bring child for review and adults sometimes may ignore due to work and time constraints?
Author Response
1. I would not mention 'low' recurrence rate for 2% per year - it is very high as pilonidal sinus affects young population. So overall recurrence rate is very high. So stating it is low is actually misleading. - abstract 2nd line and introduction/discussion segment please ensure this is corrected.
We have corrected the wording in the abstract, the introducton, and the discussion. In the latter, we have put the recurrence rate into context using the example of inguinal hernia was another common surgical disease.
2. Logically and by common sense 2.9 months time to recurrence is not due to pathology but by poor or inadequate surgery or surgical skills or training etc. So we should not blame very early recurrence either to child or infant or adult, because it is about technique and not patient.
We have removed this point from the manuscript.
3. You did not tell how did you search the studies. what was the methodology. which databases did u look at.
We have added this information to the last paragraph of the introduction to be transparent on the searched databases and potential restrictions of the search.
4. You did not cover the important issues in children - as the focus is on children - you are expected to discuss school absentism, parental off-duty, medico-legal implications for recurrence, insurance buying or policy exclusions and financial burden etc -- i understand there might not be data, but these are the issues that you are expected to discuss as your focus is on children
Thank you for pointing out these relevant shortcomings of our manuscript. We have covered these aspects now in the penultimate paragraph of the discussion. As you already assumed that there would be no data, we have discussed them using literature on similar aspects in the care of chronic illness in children and adolescents.
5. what about squamous carcinoma development.
There is no evidence for an increased risk of pilonidal sinus carcinoma in this patient group. We have included this into the 4th paragraph of the discussion.
6. any role of obesity? any role of smoking and is this the reasons for recurrence
Based on the available literature, there seems to be no role for either of them. We have discussed both aspects in the 3rd paragraph of the discussion.
7. is the recurrence solely due to better care by parents so they check and bring child for review and adults sometimes may ignore due to work and time constraints?
We don't feel that this might be a factor. It might rather be the case that the true difference in recurrence rates could be lower, because outside from randomised-controlled trials, adults might change clinic in which the recurrence is treated. Survey data point towards this, because respondents report a higher percentage of recurrences treated in their practice, but a lower recurrence rate in their own patients. This seems unlikely that only these with lower recurrence rates answer the survey. In inguinal hernia, it has been observed that patients change the healthcare provider when they experience a recurrence. This might be easier for adults, because there are simply more general surgeons than paediatric surgeons for children. This has been discussed in the sixth paragraph of the discussion.
Round 2
Reviewer 1 Report
Comments and Suggestions for AuthorsRevised manuscript worth of publishing.
