180 Chapter 7 Our study has limitations. Due to the retrospective nature of this cohort the available data is limited, which might influence the validity of the results. Our sensitivity analysis, including only anomalies with at least one year of follow up, suggests that the lack of long-term follow up in some anomalies might have led to an underestimate of the incidence. Also, whilst exposure to the risk factors found in our model will partly explain IH development, surely other disease-specific factors contribute to the increased risk in these anomalies. However, investigation of these factors is beyond the scope of this study. Another limitation is the use of clinical definitions. which might have resulted in observer bias. An objective scoring system for paediatric IH has not been developed. We have retrospectively used the classification of the EHS, proposed for adults, to systematically describe the location of the IHs in case this would be helpful for future systematic comparison (Appendix 2). Unfortunately, the length and width of the IHs were not retrievable. We grouped all IHs occurring within 15 days into early hernias. These hernias, however, are sometimes also referred to as “Platzbauch” or total fascial dehiscence, which could have a different etiology than IHs occurring later. Nevertheless, subgroup analysis comparing early and late hernias showed the distribution of the risk factors were similar in both groups. Thus, including these hernias did not influence our risk factors. Although these limitations might have influenced the outcomes, we feel that the large scale of our cohort, including only operations in infants and all anomalies available, made it possible to identify high risk diseases and general risk factors for the development of incisional hernia in an understudied infantile cohort. In conclusion we found that one in twenty infants experiences IH following abdominal surgery, which is higher than previously described. Understanding the incidence of IH and associated risk factors will allow physicians to both identify infants that may be at increased risk for IH and possibly act pre-emptively. Acknowledgments We would like to thank Raymond Bus for proofreading and language assistance.
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