296 Chapter 14 It seems logical that by tunnelling a catheter subcutaneously before entering a vein an extra barrier is created which disable pathogens to enter the bloodstream. However, based on a study conducted in NICU patients, some clinicians tend to suggest the contrary. [6] We however, believe that these results might be influenced by selection bias. In this study nearly 50% of the non-tunneled catheters were removed without complications within a week of insertion, whilst the same occurred in just 10% all tunneled catheters. It thus seems that in this study patients who were less likely to experience long-term feeding difficulties were more likely to be treated by a non-tunneled catheter. Since we and others suggest that longer dwell time increases the risk of CLABSI, this might be the confounding factor. Secondly, we evaluated the complication incisional hernia. We reported an incidence of 5% in our cohort. This increased to 7% if all cases with less than a year of follow-up were excluded. One in seven of these hernias resolved by itself, without the need for redo surgery. Out of all included diseases, those suffering from necrotizing enterocolitis, gastroschisis and omphalocele were most at risk. The occurrence of wound infections, a history of prematurity, and a history of treatment with an enterostomy significantly increased the risk of hernia development. The first observation we made was that the burden of incisional hernia can mostly be found the younger population instead of older patients. We argue that this is mostly due to the types of diseases young patients are treated for resulting, for instance, more often in enterostomy formation. It therefore seems wrong to evaluate incidence of incisional hernia including children of all different ages (mostly ranging from zero to 16 or 18) as many previous studies have done. Lastly, we have to underline that one in seven of our reported incisional hernias resolve by itself without the need for surgery. We stress the option of wait-and-see, as is already current practice at our institution. In our cohort none of these resolved hernias resulted in emergency surgery due to a strangulated hernia. Thirdly we set-out to evaluate the long-term complication adhesive small bowel obstruction. We reported an overall incidence of adhesive obstruction of 5%., still 1% of the patients experienced SBOs following laparoscopy Though seemingly less likely than following laparotomy. Of all diseases, NEC, gastroschisis and intestinal atresias seemed most at risk for the development of SBO. Risk factors for SBO development in young children are history of an enterostomy, undergoing an emergency operation and post-operative infections.
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