274 Chapter 13 Following consent, patient records were checked for eligibility. Data was retrieved and stored in an electronic database (Castor EDC). The STARD criteria were followed(11). Data extraction We (RES, LES) extracted information concerning: diagnosis leading to stoma formation, if stoma was formed as primary treatment or secondary due to complications, if patients underwent contrast enema, if the enema was performed via the stoma (antegrade) or anus (retrograde), if complications (allergic reaction or perforation) occurred during or following contrast enema, if strictures were seen on contrast enema, time from contrast enema until stoma reversal, if a stricture was identified during stoma reversal, if a stricture was identified during redo-surgery within three months following stoma reversal and time from reversal to identification of this missed strictures. Lastly the follow-up since primary surgery was collected. In case of doubt an experienced pediatric surgeon (JD) was consulted. Current practice of the contrast enema At our institute a contrast enema prior to stoma reversal is performed ideally within four weeks before stoma reversal. Omnipaque© is used as contrast. The Foley catheter size is chosen based on the size of the stoma. A balloon might be inflated during the exam to prevent leakage of contrast, given no contraindications for inflating a balloon is present. The enema is preferably performed antegrade via the mucous fistula but in some cases, e.g. anterograde filling is suboptimal or does not reach the rectum, the enema is performed retrograde via the anus. Contrast enemas are performed and evaluated by specialized pediatric radiologists at our institute. Outcome measures The primary outcome was the diagnostic accuracy of the contrast enema in finding a stricture distal of the stoma. The results of the contrast enema were retrospectively collected. In case of doubt an experienced radiologist (JS) was consulted. If the images of the contrast enemas were no longer available and no definite conclusions could be made based on the written report, a contrast enema was deemed inconclusive. If the contrast enema was deemed inconclusive, this enema was not included in the analysis of the diagnostic accuracy. Identification and treatment during surgery of the strictures, either at stoma reversal or within three months following reversal, was used as the gold standard for intestinal strictures distal of the mucous fistula. In case of a missed second, more distal, stricture in a patient who received treatment for a first stricture, only the diagnostic results of the enema for the first stricture was taken into account. Secondary outcome measures were the incidence of intestinal strictures and the incidence of missed intestinal strictures which were identified during redo-surgery within three months of stoma reversal.
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