196 Chapter 8 separately. Previous studies on the incidence of SBO young children and neonates mostly report an incidence of SBO between 3-8%, which is comparable to our results [1, 2, 4, 6, 7]. In studies including older children the incidence drops to values between 1-2% [2, 7, 9]. It has been suggested that this is caused by the predominance of appendectomies in cohorts of older children. This acquired disease has a low SBO-incidence of between 0-1% [2, 8]. Our results do not align with a recent study by Fredriksson, which found an incidence of 12.6% in infants up to one year [15]. They argued that this high incidence might be caused by inclusion of many high risk diseases combined with their longterm follow-up (mean 14.7 years). Since we included the same diseases in even higher numbers and since the difference in SBO incidence is so large, it seems questionable if this difference is only explained by duration of follow-up. Part of the difference might be caused by changes in surgical treatment. Some studies, including patients undergoing surgery before the year 2000, have suggested that Hirschsprung disease is a high risk disease for SBO whilst our study shows low risk [5, 7, 8]. The operative technique for HD has changed significantly over the years resulting in a preference for the single stage procedure (e.g. Duhamel and trans-anal endorectal pull-through). Previously, patients underwent a two staged procedure; first a colostomy and later a resection via laparotomy [6, 16]. Our results might suggest that, now that the single stage procedure has replaced the multiple staged procedure, the SBO incidence in HD seems to have decreased. Our study agrees with the previous literature that NEC, gastroschisis and small intestinal atresias are high risk diseases [1, 2, 4-8]. Our study described a large cohort, including 2-3 times the amount of patients per disease compared to previous studies that have reported SBO incidence up to 25% [5]. Because of this large cohort, we believe our results are a more accurate approximation of the true incidence of these high risk diseases. Furthermore, our data suggest that diaphragmatic hernia and meconium ileus are also more at risk for SBO development [4, 7, 8]. Yet, due to the rarity of these diseases, the number of included patients in this study was low and no definite conclusions can be made. Due to the size of our cohort, we were able to re-evaluate previously suggested hazards as well as evaluate new ones. A history of stoma seems the most important risk factor for SBO with a hazard ratio of 3.6. Taking a closer look at the data suggests this effect might be more related to ileostomies than colostomies. Whilst intestinal atresia and NEC had high incidences of SBO, ARM and HD incidence was comparatively low. Yet these two diseases of the colon contributed significantly to the total amount of patients with a stoma. This could suggest that SBOs in young children are less common following pathologies resulting in colostomies [2]. A primary anastomosis was not a significant
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