171 Incisional hernia after abdominal surgery in infants: A retrospective analysis of incidence and risk factors Chapter 7 Introduction Incisional hernia (IH) following abdominal surgery is a complication extensively studied in adults but less in infants (defined as under three years of age). IH can, in rare cases, lead to life-threatening complications such as incarceration and bowel strangulation [1, 2]. Although some IHs in infants seem to resolve over time, most need redo surgery, which might influence neurodevelopment and the quality of life [3, 4]. Since incidence and general risk factors of IH in infants are scarcely reported, paediatric surgeons mostly refer to studies pertaining to adults. The validity of applying the same risk factors in infants as in adults is questionable and has not been studied [5]. Studies that do report on IH in the paediatric population in general report an incidence between one and three percent [6-10]. These studies suggested that those suffering from necrotizing enterocolitis (NEC) and infantile hypertrophic pyloric stenosis (PS) are potentially more at risk for the development of IH. Additionally, a history of stoma formation and surgery during the neonatal phase has been reported to be correlated to IH [6, 7]. The strength of these conclusions is uncertain since these studies included between 7 and 21 children with an IH, resulting in low statistical power. Additionally, most studies excluded laparoscopically treated patients even though trocar site IHs have been described in young children [8, 9]. Furthermore, the studies used wide age-ranges at the time of the main surgical procedure, extending from the neonatal age up to 15 years, which decreases the generalizability of these results. Since information on IH specifically for the infantile cohort seems scarce the purpose of our study was to answer the following questions: (1) What is the incidence of IH following abdominal surgery in infants? (2) Which surgical diseases entail the highest risk of IH? and (3) What are risk factors for IH in the infantile cohort? Method Patients and management All consecutive paediatric patients undergoing abdominal surgery between January 1998 and December 2018 at the Amsterdam university medical centres, tertiary paediatric surgical centres, were enrolled from a surgical administrative database. Our institute data managers used a three step extraction method to include all eligible patients based on: 1) ICD-codes for all abdominal diseases, 2) operation codes for all abdominal procedures and 3) having been in an operation room at our institute before the age of 3. All included patients were checked manually for eligibility by the researchers and data was retrieved and stored in Castor EDC, an online-based database, by a medical doctor
RkJQdWJsaXNoZXIy MTk4NDMw