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325 16 Outcomes of surgical management colectomy was performed in a teenager that refused an ostomy. The choice for an initial ileostomy was based on the results of colonic dysmotility, based on abnormal transit studies or colonicmanometry, or in childrenwhohad tried transanal rectal irrigationwithout success. A colostomy was initially performed if diagnostic investigations showed abnormalities of only the descending colon or if successful rectal irrigation had been successful but was no longer possible due to psychosocial problems. Unfortunately, due to the lack of guidelines regarding the diagnostic work-up and management of children with intractable FC, it remains difficult to decide which surgical intervention should be performed in each case. We present the experience of our center, but without recommended guidelines the choice for surgery will likely differ among centers. The successful outcomes reported in our patients are in line with previous reports in the medical and surgical literature. Nine of 10 studies included in the analyses of the recently published systematic review by Siminas et al ., reported favorable results after colon resections and anastomosis. Outcomes were successful in 84% of patients and reoperations were only required in 11%. On the other hand, a study by Christison-Lagay et al . described poor results, with a successful outcome achieved only in 22%. 7 The systematic review by Siminas et al . showed that treatment success of colonic diversion ranged between 83 and 100%. However, complication rates were significant, with a morbidity rate up to 40%. 11 The high rate of abdominal cutaneous nerve entrapment syndrome (ACNES) could possibly be explained by the usage of a Pfannenstiel incision in patients undergoing a subtotal colectomy. This incision has been associated with chronic abdominal pain because of nerve entrapment. 24,25 Although we reported a higher rate of stoma-related complications in our study (81%), our results are similar to a study by Formijne Jonkers et al . 26 They included 100 adult patients who underwent intestinal stoma formation for different indications (e.g., colorectal malignancies, complicated diverticulitis, inflammatory bowel disease, anastomotic leakage) and reported that 82% of adult patients had one or more stoma- related complications. Described differences in treatment success and complications could also be partially caused by differences in definitions of treatment success and outcome measures. Siminas et al . reported that the diagnostic work-up varied significantly in studies, ranging from “no work-up” to “a full set”. 11 A comprehensive preoperative evaluation is important to exclude underlying pathology. Our results show that differences in the preoperative diagnostic work-up also exist in our center. In 10 patients, no rectal biopsies or anorectal manometry testing was performed. Although in these children Hirschsprung's disease was very unlikely because constipation symptoms started at puberty, one could argue that these tests should be performed in every case before surgical interventions are considered. Since colonic manometry has only recently become available in our center, colonic motility