14781-koppen

326 Chapter 16 testing was performed only in a minority of patients. Although the precise role of colonic manometry in surgical decision making is currently not well defined 11 , colonic manometry is currently being used to guide surgery by identifying dysmotile colonic segments that can be resected or bypassed via a stoma 1,7,9 and to guide decision making regarding re- anastomosis after a period of diversion. 8 Since patient selection is of key importance for the success of surgical treatment, guidelines regarding preoperative testing are needed. It should be emphasized that the aim of this study was not to determine what the best treatment strategies for intractable FC are. We aimed to evaluate and present our current practice and outcomes of surgical treatment in children with FC. The limitations of this study are the small sample size, the retrospective study design, and a variable number of study results that were not available for each patient. We could not gather more detailed information about bowel habits prior to the surgical intervention other than what was reported in the medical charts. Although our sample size was small, it was larger than previously published studies on this topic. 11 Furthermore, we used a self-developed non- validated questionnaire, not taking into account validated measurements before and after treatment. There is a crucial need for guidelines to guide physicians in the process of surgical decision making in children with intractable FC. Therefore, prospective studies on the surgical management of these challenging patients, and on the impact of these interventions, are needed, preferably using validated quality of life questionnaires and symptom-based outcome measures (bowel diary and fecal incontinence scores). In addition, standardized definitions and outcomes of treatment success are necessary to compare the results of clinical trials. In conclusion, surgical interventions can lead to improvement of FC symptoms in children with intractable FC. Despite considerable morbidity and complications, parental satisfaction is high. Prospective, high-quality research is necessary to develop guidelines for the diagnostic work-up and surgical management in children with intractable FC. Since this concerns a specific small subset of patients, a multicenter study approach would be preferred.