292 Chapter 14 Overview This thesis has aimed to close a knowledge gap on the occurrence of different types of complications following abdominal surgery in young children as well as the occurrence of the complications following treatment by an enterostomy in the same cohort of patients. It aims not only to inform but also to inspire change by presenting risk factors for complications. Our believe is that based on these risk factors, actions and ideas for prevention may follow which could thereby avoid complications in future patients. First, it was important to get an overview of the extend of the occurrence of different types of complications. This was of particular importance in congenital abdominal diseases, which incidences are largely unknown due their rare nature. Due to the small number of patients in most cohorts, incidences of complications will differ significantly between cohorts implying the need for a structured review. This is what we set out to do in Part I. We started with infectious complications. Taking into account all congenital abdominal diseases treated with surgery, the overall occurrence rates of complications were; 6% for wound infections, 4% for wound dehiscence, 3% for anastomotic leakage, 3% for post-operative peritonitis and 2% for fistula development. Though differences were noted between different diseases, our figures gave the impression that these incidences were fairly similar between many diseases. The only exception being the occurrence of anastomotic leakage which seemed to occur comparatively more often following treatment for atresias than other diseases. Next were obstructive complications. According to our review, these incidences were 7% for paralytic ileus, 6% for adhesive small bowel obstruction, 3% for anastomotic stenosis within one month after surgery and 4% after one month. Paralytic ileus seems to occur more often in patients treated for gastroschisis whilst adhesive small bowel obstructions seemingly occur more often following treatment for gastroschisis, intestinal atresia, diaphragmatic hernia and malrotations. During the process of composing this review we noted that many studies did not report a definition of ileus. Since an ileus is a clinical diagnosis, it is likely that there will be differences in the interpretation of the term. That is why we composed a review analyzing the available literature on the reported definitions and outcome measures of postoperative ileus used in children. This review showed that less than half of the articles discussing this subject defined the outcome. Moreover, a multitude of outcome measures were used of which roughly a third were used only once. This variation hampers the interpretation of the results and decreases the comparability amongst studies. It was
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