The author replaced the aim of the work by the primary outcome. it is advisable to add the aim of the work at the end of the introduction which gives a better idea about the study than the primary outcome. The methodology is clear and the findings clear; however, not supported by the patients number due to early termination of the study. The title of the study is relevant and follows the CONSORT guidelines for reporting the clinical trials. The references are relevant, recent and referenced correctly, in addition; important studies were included.

The introduction is too long and doesn't provide a clear overview on the topic with a lost of basic science revision. The research question was not clearly written in the introduction and the authors should write it at the end of the introduction.

Subject selection is clear with proper inclusion and exclusion criteria Study variables were defined and measured appropriately Study methods are valid but reliability was limited due to sample size limitation . Proper description was provided to replicate the study. Study flow chart was provided. However, the two groups are different as regard to the treatment provided since the surgical group was provided with additional procedure. The primary outcome is not well chosen to compare the groups with this patients' number.

The data were presented in an appropriate way. Tables and figures are relevant and clearly presented and appropriate units were used. Table are properly titled and categories were grouped appropriately. There is repetition of data in the text and tables.

The results were discussed properly however the conclusion is limited by the number of patient. The study has a major limitation of early termination which made the conclusion unreliable and further studies are required.

In general the study design is appropriate but it failed to answer the research question due to early termination.