308 Appendices ENGLISH SUMMARY Part I - Introduction The specialization of medical care for children have led to an increase in surgical procedures in young children in Europe and will in time also spread to low- and middleincome countries. Due to these developments we should now improve surgical care by reducing the complications of surgery. This is why this thesis specifically will focus on complications of abdominal surgery in patients treated at a young age. Part II – Incidence of postoperative complications based on the available literature Since congenital abdominal diseases are rare, large cohort studies are scarce. Therefore, the incidences of complications following surgery in these patients are largely unknown. We developed three separate reviews to evaluate the occurrence of these complications. These reviews showed that important complications are not uncommon. For instance wound infections occurred in 6% of the patients, anastomotic leakage in 3%, anastomotic stenosis in 4%, adhesive small bowel obstruction in 6% and incisional hernia in 4%. Since a set definition was lacking we evaluated the used outcome measures and definitions for ileus in a separate review. This review found that less than half of the articles on postoperative ileus or bowel function in children defined the outcome, with a variety of outcome measures used, decreasing comparability among studies. Part III - Incidence of- and risk factors for postoperative complications in our cohort In this part we evaluated our own cohort of patients treated between 1998 and 2018 at our clinic. We started out with central line associated bloodstream infections and thrombosis in patients treated for intestinal atresias or gastroschisis. These infections developed in one third of our patients. Enterostomy formation and non-tunnelled catheters significantly increased this risk. The high incidence of CLABSI furthermore led to action by means of prevention. Because of this, we set up a multidisciplinary team dedicated to central line management and we recently started with taurolidine, a line-lock infusion. The effects of this intervention we aim to re-evaluate in the nearby future.
RkJQdWJsaXNoZXIy MTk4NDMw