48 Chapter 2 was under 50, no separate pooled proportions were calculated for the included anomalies. The included anomalies are: anorectal malformations (N=2/150), omphalocele (N=2/70), congenital diaphragmatic hernia (N=1/57) and gastroschisis (N=2/54). Discussion In this review we report the pooled proportions of SSIs after surgical correction of abdominal birth defects. These proportions approximate the incidences of these complications. Thus, our meta-analysis results in the following incidences: 6% for wound infection, 4% for wound dehiscence, 3% for anastomotic leakage, 3% for post-operative peritonitis and 2% for fistula development. Gastroschisis, omphalocele and small intestinal atresia are generally more at risk of wound infections compared to other birth defects. This could partly be explained by the neonatal age and the relatively high proportion of premature born infants with these birth defects. More than half of the gastroschisis patients are born prematurely compared to only 6% in Hirschsprung’s disease patients. [189, 190] It is suggested that prematurely born children have an underdeveloped gastrointestinal system as well as an underdeveloped immune response, making them more prone to infections .[191, 192] Due to the lack of consensus on paediatric anastomosis between paediatric surgeons, preferences in techniques and materials used to create an anastomosis differ. [18] Despite these different approaches, anastomotic leakage is not often mentioned in studies pertaining to infants compared to older children or adults. [18] The occurrence of anastomotic leakage is likely influenced by the size discrepancy between the dilated proximal and smaller distal part of the intestine in diseases such as small intestinal- and colonic atresia, which makes it harder to create an adequate anastomosis. [193] Since the reported incidence of both post-operative peritonitis and fistula development are low, no separate analysis was done per birth defect. Post-operative peritonitis in adults is mostly seen as a result of anastomotic leakage, but could also be the result of a bacterial leak from any abdominal organ or the bloodstream.[194] In our infantile cohort we found that post-operative peritonitis and anastomotic leakage both had an incidence of 3%. Thus, pooling both results would not have influenced overall incidence. Since we wanted to follow definitions as stated in the original articles, we decided to report both complications separately.
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