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324 Chapter 16 Parental satisfaction The majority (91%) of parents was satisfied with the results of the surgical intervention. The median postoperative satisfaction score for the total group was 8 (range 2–10), for parents of patients with an ostomy was 7 (range 2–10) and for parents of patients in whom continuity was reestablished was 8 (5–10). All except one parent would make the same decision in choosing a surgical approach for their child. This was the parent of a child with persistent constipation despite current treatment with laxatives and rectal irrigation after surgery (Table 4, patient 35). DISCUSSION This study shows that surgery can be an effective treatment option for children with intractable FC. Although the majority of patients required multiple surgical procedures, intestinal continuity was successfully reestablished in more than half of our patients. Treatment success was reported in 85% of all patients, including 88% of children who underwent closure of their stoma and 82% of children who still had an ostomy. Intractable FC is a difficult and frustrating problem for healthcare providers, parents and children. When intensive (non-)pharmacological management (including bowel regimens with oral and/or rectal enemas) is ineffective, alternative and more invasive treatment modalities need to be sought. Surgical interventions should only be considered in severe cases when maximal medical therapies have failed and symptoms significantly affect the child's quality of life. Invasive surgery for FC is preferably performed in specialized centers and requires close collaboration between pediatric gastroenterologists, pediatric surgeons, specialized stoma nurses and child psychologists. Before surgical interventions are considered in these patients, families should be counseled by this type of multidisciplinary team. Surgical interventions, especially ileostomies and colostomies, can be both physically and psychologically challenging, and therefore thorough education and psychological assessment should be performed prior to surgery. 22 The possible benefits of these major surgical interventions should be balanced against the risk of complications and stoma problems. Several surgical interventions have been described to address intractable constipation, including antegrade enema's, pull-through type procedures 16 , J-pouches 17,23 , partial or total colonic resections, and temporary or permanent diverting ileostomy or colostomy. In accordance with previous reports 7,11 , the majority of the included patients (84%) had an ileostomy or colostomy as initial surgical procedure. In five patients, an initial sigmoid resection was performed to remove a dilated sigmoid colon. In addition, one initial subtotal