293 Conclusions, general discussion and future perspectives Chapter 14 notable that most reported outcome measures for ileus in children focused on return of gastric motility rather than return of intestinal motility as is the case in adults. [1] We argue that since ileus is a clinical diagnosis, the outcome measures used are defined by whichever factor influences clinical outcome most. Since young children have comparatively little reserves, intake is more important for this patient group compared to adults. This could explain the differences in outcome measures used. Following this logic, it seems that a since recently available core outcome set for adults would not suffice in children due to this difference, underlying the need of a specific set of outcomes focusing on this patient group. Lastly, we evaluated the occurrence of incisional hernia. Our reported approximation of the incidence of incisional hernias was 3%. Within the different congenital diseases, gastroschisis patients seem most at risk, with an approximated incidence of 10%. Within this specific disease, it seems that those treated for complex gastroschisis (patients with gastroschisis and additional anomalies such as atresias or necrotizing enterocolitis) increased the risk of hernias occurring. We think this is caused by an increase of risk of wound infections, which is suggested to increase in the case of intestinal resection, increased length of stay or poor nutritional status.[2] All of these issues are more likely to be encountered in the case of complex gastroschisis. Patients treated with SILO treatment were also more at risk of incisional hernia. We do believe that in most of these patients the need of SILO treatment will be a reflection of the larger size of the gastroschisis. The increased size of the abdominal defect combined with the increased pressure could be a probable cause of later incisional hernias. However, we do believe that in case of doubt if SILO treatment is necessary, these results, in addition to other studies, could mean leaning towards primary closure instead of SILO closure. Additionally, though future research is necessary, we do applaud treatments which look for alternatives to SILO closure, such as sutureless closure.[3] We came to this approximation of the incidences of these complications following treatment for congenital abdominal anomalies by accumulating all available literature. These studies mostly consisted of small cohorts due to the rarity of the diseases. There are multiple small cohorts reporting less or even zero complications. Focusing on these results, instead of the bigger picture, might have resulted in the persisting believe that complications in young children are rare and therefore might not imply the need of action. This same lack of action can result from the believe that, due to the small cohort sizes, it is hard to study risks of- and risk factors for complications in this group of patients. It is true that large cohorts are needed to perform predictive or regressive analysis and that including enough patients will take time. Countries that have organized large prospective
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