17 General introduction Chapter 1 Aims of this thesis This thesis has aimed to close a knowledge gap on the occurrence of different types of complications following abdominal surgery in young children as well as the occurrence of the complications following treatment by stoma in the same cohort of patients This thesis aims to close a knowledge gap on the occurrence of different types of complications and their risk factors following abdominal surgery in young children as well as the occurrence of the complications following treatment by stoma in the same cohort of patients. This information may provide a basis for research and decision making into changes in surgical practice aiming to decrease the occurrence of these complications. Thesis outline Though surgical interventions in young children are now common, limited knowledge exists on the rate of postoperative complications. For this reason, we aggregated the available literature on three different overarching types of complications, namely infectious, obstructive and incisional hernias. This resulted in three separate systematic reviews showing the incidences of different types of complications, which are all provided in Part II. From here onwards we separately evaluated complications in our manually created database including all patients who underwent abdominal surgery in the two recently merged university hospitals of Amsterdam now called the Amsterdam UMC. This resulted in Part III in which the incidence of- and risk factors for short term complications such as central catheter associated infection/thrombosis or complications of primary anastomosis are evaluated. Likewise, this is done for long-term complications such as incisional hernia and adhesive bowel obstruction. Moreover, by providing an overview of the outcome measures used in the literature to describe pediatric postoperative ileus, this chapter builds one of the findings of Part 1 suggesting high variation in definitions as well as outcome measures. This is the start of the path towards a core-outcome set. Part IV focusses specifically on young children treated with an enterostomy. It shows the risks related to having an enterostomy at a young age. These risks entail the risk of growth impairment but also enterostomy related morbidity. Moreover, this chapter will show that it seems unwise to perform a routine contrast enema prior to enterostomy reversal except following treatment for necrotizing enterocolitis. Taking into account these risks as well as the risks of primary anastomosis provided in Chapter III, this chapter closes by summarising the aggregated risks of complications following both enterostomy formation and reversal to primary anastomosis in patients treated for jejunoileal atresia.
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