189 Adhesive small bowel obstruction following abdominal surgery in young children (≤ 3 years) Chapter 8 Introduction Adhesions are an inevitable consequence of abdominal surgery and can cause small bowel obstruction (SBO) in young children. Although the incidence of SBO depends on the type of surgery and age, the incidence varies between 1-13% in children [1-7]. Whilst it seems that the incidence in young children is higher than in older children, most studies in paediatric patients included children of wide age ranges [1, 2, 7-9]. Moreover, although in recent years a shift has taken place from open procedure to laparoscopic treatment, most studies did not include patients treated by laparoscopy [1, 2, 5, 7-9]. When an SBO occurs in adults it is often treated conservatively, whilst in children the treatment mostly requires surgery [1-3, 5, 8]. Surgical treatment for SBO, and the failure of non-operative treatment, seems to be more often necessary in cohorts of children younger than one year than in cohorts of older children [10]. An explanation for this finding could be that in cohorts including older patients, a higher percentage of the cohort is treated for appendicitis. Previous research has suggested that if a SBO occurs following an appendectomy in children, conservative treatment seems effective in a large proportion of cases[11].. Mortality caused by SBO occurs in 0-4% of the children due to delayed diagnosis and treatment [7, 8, 12]. If more information was available on incidence, high risk diseases and risk factors for SBO in young children, preventative strategies could be developed specifically for this young cohort. Moreover, this information could be useful in counselling parents and caregivers. Therefore, the aim of this retrospective cohort study, including all young children who received abdominal surgery between 1998-2018 in our tertiary clinic, was to answer the following questions: (1) What is the incidence of SBO in our cohort? (2) Which surgical diseases entail highest risk of SBO? and (3) What are general risk factors for SBO in our cohort? Methods Patients and management Our institute’s data managers retrieved all young children (defined as before the age of three years) undergoing abdominal surgery between January 1998 and December 2018 from the Amsterdam university hospital database. The local medical ethical commission evaluated the study (“non-WMO”), it received the refence number W18_233#18.278. An opt-out letter was sent to patients and parents, which they could return within three months if they did not wish to participate. Following these three months, patient records were checked if all patients were correctly identified. Eventually ,the data of the included
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