191 Adhesive small bowel obstruction following abdominal surgery in young children (≤ 3 years) Chapter 8 Significant risk factors were reported in hazard ratio (HR) with complementary 95% confidence intervals (95%-CI). Separate logistic regression was performed to evaluate the influence of surgical approach on the outcome of SBO development. The outcome was reported in odds ratio (OR) with complementary 95% confidence intervals (95%-CI). Results Patient and surgical characteristics Abdominal surgery was performed in 2066 young children. Since 11 patients declined participation, 2055 young children were included. In total 43 different diseases were included (Appendix 1). The most reported primary pathologies were infantile hypertrophic pyloric stenosis (PS) (20%; N=420/2055), anorectal malformations (ARM) (12%, N=240/2055) and necrotizing enterocolitis (NEC) (9%, N=189/2055). Patients’ characteristics of the overall cohort are displayed in Table 1. In 2055 patients, 66% were male and 28% were born preterm. The median age at primary surgery was 47 days (range: 0 – 1095). Laparotomy was performed in 79% of the young children (N=1616/2055). Infectious complications following primary surgery were seen in 28% (N=462/2055, missing: 451). A history of stoma was reported in 21% (N=429/2055). The included patients had undergone a median of one operation (range: 1-13) and had a median followup of 420 days (range: 0-8006) since primary surgery. A follow-up of less than a week was available in 124 patients of which 68% (N=67/124) were operated in day surgery without follow-up at our centre, 26% (N=33/124) died within a week of surgery, 19% (N=23/124) were transferred to another centre without further follow-up and 1% (N=1/124) the status was not fully retrievable. Small bowel obstruction (SBO) SBO occurred in 5% (N=88/1931, missing: 29) of all patients with a follow-up of at least a week. This increased to 7% (N=58/880, missing: 29) if only patients with at least two years of follow-up were analysed. One-way ANOVA (p = 0.218) showed there was no significant difference in occurrence of SBO over time. Patient characteristics of those who experienced SBO are noted in Table 1 and incidence per disease are listed in Table 2. SBO occurred after a median of 99 days (range: 8 – 6185), 89% (N=78/88) of the SBO occurred within two years. Diaphragmatic hernia, meconium ileus, pseudo obstruction, gastric perforation and focal intestinal perforation showed high proportions of SBO in diseases but each had less than 50 included patients. Gastroschisis (17%, N=9/53), NEC (8%, N=15/188) and intestinal atresia (7%, N=13/177) reported highest incidence in diseases with more than 50 included patients. For these high risk diseases, a Kaplan-Meier curve of the first two years of follow-up after primary surgery is provided in Figure 1.
RkJQdWJsaXNoZXIy MTk4NDMw