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319 16 Outcomes of surgical management was rated with a yes-no question, and on a scale of 1–10 (1 = very unsatisfied with the result, 10 = very satisfied with the result) (Supplemental file 1). The telephone questionnaire took approximately 10 minutes to administer. Statistical analysis Data were analyzed using IBM SPSS Statistics for Windows v 22.0 (IBM Corporation Armonk, NY, USA). Results are shown as percentages of the total sample unless otherwise specified. Results are expressed as means or medians, depending on whether the data were normally distributed or not. RESULTS Patient characteristics Patient characteristics of all 37 included children (68% female) who underwent surgery for intractable FC are depicted in Table 1. At the first appointment in our center, the median age of the included patients was 9.1 years (range 1.2–16.7) and they underwent the first invasive surgical procedure (i.e., ostomy or [sub]total colectomy) at a median age of 12.0 years (range 1.6–17.6). A total of 23 patients (62%) experienced severe abdominal pain and 15 patients (41%) suffered from fecal incontinence at the time of presentation. In addition, in 11 children (29.7%) SNS had been tried, five (14%) had received botulinum toxin injection in the anal sphincter and nine (24%) had received an appendicostomy/cecostomy previous to the surgical interventions described in this article. The choice of the surgical procedure was discussed for every individual patient during a multidisciplinary meeting with pediatric surgeons, pediatric gastroenterologists, specialized stoma nurses, and a child psychologist. Preoperative testing The results of preoperative diagnostic investigations are shown in Table 2. In 32 children (87%) colonic transit time was measured using radiopaque markers (a capsule with 10 radio opaque markers was ingested on six consecutive days with an abdominal X-ray on day 7) 20 : 25 (78%) had proven slow transit constipation (>62 hours) and the remaining seven (22%) had normal transit (<62 hours). However, two children diagnosed with “normal colonic transit”had continued to take their laxatives during the test. In 18 children anorectal manometry was performed, and all 18 children had a normal rectoanal inhibitory reflex (RAIR) and normal anal sphincter resting pressure. Ganglion cells were present in all 19 children in whom rectal biopsies were taken. In 10 children, no anorectal manometry or rectal biopsies were performed. Twelve patients underwent defecography: among them