14781-koppen

291 Surgical decision-making 14 Limitations This survey was intended to acquire more information on the current diagnostic and therapeutic approach towards children with FC, especially with regard to manometry and surgical interventions, and was therefore administered to physicians from both pediatric surgery and pediatric gastroenterology. Since the questionnaire was administered during a conference, it was kept brief to increase the response rate. Although we tried to be comprehensive, it would have been interesting to obtain more detailed information (e.g., regarding the specific dietary advice given or the maximum dosage of medication used). In addition, it would have been interesting to explore why physicians chose certain answers. To assess this, an interview-based study would be necessary. Furthermore, this survey was administered to physicians attending a conference on colorectal diseases and disorders, likely representing physicians with a special interest in this topic. It is unknown whether this sample is a fair representation of pediatric surgeons and gastroenterologists in general. However, since manometry and surgery in the management of intractable FC are usually performed in specialized centers and by specialized physicians, we assume that this is a reliable representation of the population that we wanted to study and in fact may even underestimate the inconsistencies that exist in clinical practice. Additionally, our study is at risk for selection bias. We could not specify the specialty of the physicians attending the conference in Nijmegen (the Netherlands), therefore we were unable to provide an exact response rate. However, if all physicians attending the conference in Nijmegen were from pediatric surgery or gastroenterology, the response rate for this survey would have been 74/(100 + 118) = 31%. If the distribution of physicians in Nijmegen was similar to that in Columbus (68% of attending physicians from pediatric surgery/gastroenterology), the response rate would have been 74/(100 + (0.68*118)) = 41%. Finally, the group of responders consisted of staff members and fellows. It is possible that the fellows were less experienced in the field of motility studies, which may have influenced the results. However, for each question responders could indicate if they did not know the answer or if the question was not applicable to them. Therefore, we assume that responders who answered the questions indeed gave answers that reflect their true personal approach. CONCLUSIONS Surgical decision-making for children with intractable FC differs among physicians worldwide. Anorectal and colonic manometry are often used to guide surgical decision- making. However, since there are no guidelines for surgical management of FC in children, the application and interpretation of manometry vary among physicians, resulting in