301 Conclusions, general discussion and future perspectives Chapter 14 show that not only more severe (Clavien-Dindo grade ≥III) complications occur following enterostomy formation but that both short- and long-term complications occur more frequent in this group of patients. These results strengthen our believe that there are groups of patients in whom an enterostomy could be prevented and we encourage others to aid in this paradigm shift by identifying more groups of patients like those treated for jejunoileal atresias which could benefit from a lower threshold of primary anastomosis development. When an enterostomy is deemed necessary, many surgeons still opt to perform a contrast enema prior to enterostomy reversal in order to identify strictures distal of the enterostomy. In our last paper on routine contrast enema prior to enterostomy reversal we show that the diagnostic accuracy of the contrast enema in detecting these strictures, which occur in 10% of the patients, is high (AUC: 0.98). However, almost all cases of stricture were identified in those children treated for necrotizing enterocolitis. Because of this we advise to only perform a contrast enema prior to enterostomy reversal in this group of patients, preventing all other form this unnecessary diagnostic. When performing a contrast enema in NEC patients, we advise to first perform a retrograde enema instead of an antegrade enema due to lower chances of false positive results. However, in case of uncertainty, an antegrade enema could be added in order to identify multiple strictures or to assure no stenosis is present.[17] Conclusion With the completion of this thesis a deeper insight is reached of the occurrence of and risk factors for post-operative complications following abdominal surgery at a young age with inclusion of all patients. Instead of focusing on specific details, it has given a broader overview of the cohort as a whole which has provided more general focus points for the future in order to prevent complications in the future. These steps are just the first of the marathon which we are running with towards the finish line of further improving care for this fragile patient group. However, without taking the first step forward, we would never get ahead.
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