Dear Dr. Hill,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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• A letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
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We look forward to receiving your revised manuscript.

Kind regards,

Paul Kwong-Hang Tam

Academic Editor

PLOS One

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When submitting your revision, we need you to address these additional requirements.

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“This registry is funded in part by funds received from the Montreal Children’s Hospital Foundation. The funders had no role in study design, data collection, analysis, decision to publish, or preparation of the manuscript.”

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

Reviewer #1: Yes

Reviewer #2: Yes

**********

2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses??>

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable??>

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors described where all data underlying the findings will be made available when the study is complete??>

The PLOS Data policy

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: Yes

**********

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

Reviewer #1: the authors have presented a protocol for prospective longitudinal recording of results. Such information is much needed. It is quite an ambitious protocol, and it will be interesting to see how good the adherence to the protocol will be.

Reviewer #2: The manuscript presents a well-structured, single-centre prospective registry protocol for children with Hirschsprung’s disease (HD) and anorectal malformations (ARM) in Canada. Its originality lies less in conceptual novelty—registries such as ARM-Net and PCPLC already exist—than in establishing the first dedicated paediatric colorectal registry in the Canadian context, with explicit linkage to transition and quality-of-life outcomes.

The protocol described is generally robust. Inclusion and exclusion criteria are clear, follow-up is longitudinal to age 18, and the use of validated instruments (BCS, BFS, HAQL, TRAQ) for disease-specific and patient-reported outcomes is appropriate and carefully age-stratified. The primary outcome including time to achievement of social fecal continence, is clinically meaningful. Combining HD and ARM within one infrastructure is pragmatic, and the plan to analyse cohorts separately is reassuring, but the registry’s single-centre nature and regional catchment may limit generalisability and should be more clearly discussed.

SOme specific questions as listed below

1) How will the team ensure consistency in clinical data abstraction from multidisciplinary forms?

2) How will the registry data be shared upon study completion?

3) What statistical strategies will be used to address missing PRO data and incomplete follow-up, especially given the long follow-up window to age 18?

4) Although analyses will be disease‑specific, does combining HD and ARM in a single registry risk operational or analytic heterogeneity?

5)How representative is the COCOE patient population of the broader Canadian paediatric colorectal population?

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what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review?  For information about this choice, including consent withdrawal, please see our Privacy Policy

Reviewer #1: No

Reviewer #2: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures

You may also use PLOS’s free figure tool, NAAS, to help you prepare publication quality figures: https://journals.plos.org/plosone/s/figures#loc-tools-for-figure-preparation.

NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications.

Colorectal Centre of Excellence (COCOE) Registry: A protocol for a prospective longitudinal cohort of children with Hirschsprung's disease and anorectal malformations in Canada

PONE-D-26-32069R1

Dear Dr. Hill,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Paul Kwong-Hang Tam

Academic Editor

PLOS One

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

Reviewer #2: Yes

**********

2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses??>

Reviewer #2: Yes

**********

3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable??>

Reviewer #2: Yes

**********

4. Have the authors described where all data underlying the findings will be made available when the study is complete??>

The PLOS Data policy

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #2: Yes

**********

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

Reviewer #2: Thank you for addressing my comments. I have no further comments. Congratulations to the authors for their work.

**********

what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review?  For information about this choice, including consent withdrawal, please see our Privacy Policy

Reviewer #2: No

**********