297 Conclusions, general discussion and future perspectives Chapter 14 In this complication too the incidence seems higher in young children compared to cohorts including children of all age groups. This could partly be explained by the factor time, because it seems the shorter the follow-up is, the lower the chance of SBOs becoming symptomatic.[7] However, it could well be that the predominance of (simple) appendectomies in these cohorts, which seems to have comparatively low incidence of SBOs, also decreases the overall incidence of the cohorts as a whole.[8-10] Moreover, our results suggest that most SBOs occurred within the first half year of follow-up. We would suggest to address symptoms of intestinal strangulation as a result of SBO to parents to raise awareness and decrease time from onset of symptoms to treatment, especially within this first half year following initial surgery. This should be the case for both patients treated by laparotomy or laparoscopy since, though less likely, our results underline SBOs do also occur following laparoscopic treatment. Again, treatment by enterostomy was found to be a significant risk factor, with a hazard ratio of 3.2. Moreover, diseases that mostly resulted in small bowel ostomies (e.g., NEC or intestinal atresias) showed higher incidence when compared to diseases mostly resulting in colon ostomies (e.g., Hirschsprung’s disease or ARM). Although the initial pathologies, depending on whether they affect the small bowel or the colon and the extensiveness of factors like inflammation associated to this initial pathology, may influence the risk of SBO, more than the location of the enterostomy, these results could suggest that SBOs in young children are less common following colostomies. Preventing stomas, possibly mostly ileostomies, could decrease the occurrence of SBOs which is one of the reasons discussed in this thesis why we feel that primary anastomosis should be considered more often. Lastly, we analyzed the complications anastomotic leakage and stenosis following primary anastomosis. This incidence of anastomotic complications in young children which was 7% for anastomotic stenosis and 5% for anastomotic leakage. Anastomotic stenosis occurred most often in patients treated for necrotizing enterocolitis (14%), Hirschsprung’s disease (9%) or intestinal atresia (6%). Anastomotic leakages develop most often after treatment for intestinal atresia (6%) followed by treatment for necrotizing enterocolitis (5%). The evaluation of technical factors as possible predictors for the development of anastomotic stenosis showed that colonic anastomosis is associated with an increased risk for the development of stenosis compared to those located in the small intestine. Other technical factors (type of anastomosis, suture resorption time, mode of suturing) were not significantly associated to the development of a stenosis, although end-to-end anastomosis show a trend towards increased risk of stenosis. A higher ASA score (≥III) and male sex are significantly associated with the development of anastomotic leakage. In all patients receiving a primary anastomosis, less than one percent died because of an anastomotic complication.
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