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282 Chapter 14 and pediatric surgery are involved. Intrasphincteric botulinum toxin injections and ACE are considered to be less invasive surgical strategies and are commonly employed in the treatment of intractable FC. 10 More invasive surgical interventions include colonic resection and diversion of the colon via an ostomy, either an ileostomy or a colostomy. 10,11 In their recent systematic review, Siminas et al . concluded that the evidence to support surgical interventions for intractable FC in children is mostly of low quality. 10 Siminas et al . provided a comprehensive overview of the literature and showed that there is no consensus regarding the diagnostic-work up that is required for surgical decision-making. 10 Therefore, the aim of this study was to assess the diagnostic and therapeutic approach of pediatric surgeons and pediatric gastroenterologists towards pediatric patients with intractable FC. MATERIALS AND METHODS We developed a survey and administered it to physicians attending the 2015 Pediatric Colorectal, Motility and Pelvic Reconstruction Conference, held simultaneously in Columbus, Ohio (USA) and Nijmegen (the Netherlands) in November 2015. In total, 265 physicians from different specialties (pediatric and adult surgery, gastroenterology, urology and radiology) attended the conference at both locations; 147 in Columbus and 118 in Nijmegen. In Columbus, the attendees included 71 physicians from pediatric surgery (36 faculty members, 35 fellows/residents) and 29 from pediatric gastroenterology (21 faculty members, 8 fellows/residents). In Nijmegen, the distribution of physicians according to their specialties was unknown (89 faculty members, 29 fellows/residents). The questionnaire involved 19 multiple choice questions on work experience, routine diagnostic workup in children with FC, use of non-pharmacological and pharmacological treatment for FC and use of surgery in intractable FC (Supplemental file). In addition, the survey includedmultiple choice questions on 4 theoretical cases of children with intractable FC; anorectal and colonic manometry results were given and responders were asked which surgical treatment they would choose. For each question, responders had the option to an open answer in case the multiple choice answers were insufficient. For this study, only surveys answered by physicians from pediatric surgery and pediatric gastroenterology were included. The results are represented as percentages of the total number of responders unless otherwise specified.