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283 Surgical decision-making 14 RESULTS The surveywas completed by 74 physicians working in pediatric surgery or gastroenterology in 16 different countries: 55 (74%) worked in pediatric surgery (29 faculty members, 23 fellows, 3 residents) and 19 (26%) in pediatric gastroenterology (14 faculty members, 5 fellows). The experience of these physicians was reported as follows: 0–5 years (43%), 5–10 years (25%), 10-15 years (8%) and >15 years (25%). Results are presented separately for pediatric surgery (surgery) and pediatric gastroenterology (GI) in all tables. Diagnostic work-up Table 1 summarizes the data from the questions related to the diagnostic approach. Most responders utilized digital rectal examination in the evaluation of children with FC. Plain abdominal X-rays were obtained by the majority of physicians. In total, 62/69 of responders who used plain abdominal X-rays did not use a scoring system (e.g., Barr, Leech or Blethyn 12 ) to score the radiographs. Colonic transit studies were used infrequently, whereas the use of contrast enemas was reported to be more common. Anorectal manometry Anorectal manometry was used routinely by 15 responders while 37 responders used it occasionally (Table 1). Responders who used anorectal manometry either routinely or occasionally ( n =52) utilized this test to rule out Hirschsprung’s disease (65%; 83% in GI and 56% in surgery), to diagnose anal achalasia (58%; 78% in GI and 47% in surgery), to detect dyssynergia (56%; 67% in GI and 50% in surgery), to assess sphincter integrity (50%; 50% in GI and 50% in surgery) and for guidance prior to possible pelvic floor surgery (27%; 22% in GI and 29% in surgery). Out of the 52 physicians utilizing anorectal manometry, 52% (67% in GI and 44% in surgery) would consider anal sphincter botulinum toxin injections for anal achalasia and 21% (28% in GI and 18% in surgery) would use it to treat dyssynergia. Colonic manometry Colonic manometry was used routinely by eight and occasionally by 20 responders (Table 1). Among the responders who used colonic manometry ( n =28), 61% (91% in GI and 41% in surgery) employed it to differentiate neuropathic from myopathic dysmotility, 57% (64% in GI and 53% in surgery) to guide surgical decision-making, 54% (55% in GI and 53% in surgery) to differentiate an underlying organic disease from a functional disorder and 36% (73% in GI and 12% in surgery) to assess disease severity.