197 Adhesive small bowel obstruction following abdominal surgery in young children (≤ 3 years) Chapter 8 risk factor for SBO development in our cohort. This might imply that creating a primary anastomosis, and thereby preventing an ileostomy, could lower the SBO incidence. Although safety and surgical outcomes need to be evaluated, some studies have applied primary anastomosis in specific stable patients of NEC, focal intestinal perforations and intestinal atresias with good outcomes [18-21]. Based on our own results we do not have a direct explanation why emergency operations increase the risk of SBO occurrence. It could be that emergency operations mostly occur during a phase of acute inflammation or ischemia, which increase adhesions formation [22, 23]. Combining this with our finding that post-operative infection increased the hazard of SBO, suggests that managing inflammation perioperative could influence adhesion formation and thereby SBO [5]. Proper administration of perioperative antibiotics has been shown to reduce infections in paediatric patients in general [24]. In neonatal cases however, ambiguity on this effect of perioperative antibiotics on infections exists [25]. This might be due to inappropriate timing of antibiotic administration during neonatal surgery [26]. A recent increase in the attention on correct antibiotic stewardship in neonates has resulted in the development of new guidelines [27]. However randomized controlled trials, which should be the building pillars for these guidelines, remain sparse. Number of surgical procedures confounded with having a history of stoma and was therefore not included in the cox-regression. The separate analysis in patients who did not receive a stoma suggested that an increase in number of surgical procedures enhances the risk of SBO [1, 5]. However, our data suggests that the nature of the anomaly (e.g., the necessitation of a stoma) and the reason for the operation (e.g. emergency operation) seems to be of more importance than the number of procedures. It seems that laparotomies in general have a higher risk of resulting in SBO than laparoscopies. The median follow-up for laparoscopies in our study was 75 days compared to 606 days for laparotomies. This short follow-up in most laparoscopically treated patients has led to early, possibly informative, censoring in the cox regression analysis. This could explain why in this analysis, mode of surgery was non-significant contrarily to a previous study in older children [9]. Still, it should be noted that 6% of the adhesions in our cohort occurred following laparoscopy and that in total 1% of the laparoscopically treated patients develop an SBO. This shows that the risk might be lower but not zero, which is why studies should not exclude laparoscopies.
RkJQdWJsaXNoZXIy MTk4NDMw