63 The incidence of different forms of ileus following surgery for abdominal birth defects in infants Chapter 3 Introduction Ileus following surgery, consisting of both paralytic and mechanical causes, is a frequent complication after abdominal surgery, leading to increased morbidity, mortality, medical costs, and increased length of hospital stay [200-203]. It is a clinical diagnosis which is characterized by intolerance to oral feeds, vomiting, abdominal distention, and the absence of flatus or stool. Ileus following surgery can arise in different forms which depend on the definition used. Common causes are paralytic ileus, adhesive small bowel obstruction (SBO) and anastomotic stenosis. Paralytic ileus is a transient form of ileus which arises shortly after the operation in a response to surgical stress and is based on temporarily intestinal paralysis [204]. Anastomotic stenosis and SBO are mechanical forms of ileus that present later after surgery and could lead to reoperation. Since abdominal birth defects are rare, the incidence of these forms of ileus are not well known. Yet, knowing the incidences would provide context for clinical decision making as well as a starting point for future research into preventative measures. Therefore, the objective of this review is to systematically aggregate the available data on the incidence of different forms of ileus following surgery for birth defects in infants. Methods Studies were selected according to the criteria outlined below based on the PRISMA Guidelines [31]. Our protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 7 March 2019 (registration number: CRD42019119268). Participants All studies reporting on any form of ileus following surgery for birth defects as primary of secondary endpoint were considered eligible. Only articles that described infants (≤ three years) and specifically named the different forms of ileus were included. Animal studies, in vitro studies, non-English or non-Dutch articles, congress abstracts and studies with less than ten cases were excluded. Search strategy The electronic databases of the National Institutes of Health PubMed and EMBASE were systematically searched in February 2020 using both simple search terms as well as hierarchical family forms (e.g. MESH). The search strategy was designed together with a medical information specialist (RV). It combined four groups of search terms
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