TY - JOUR
T1 - Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO)
T2 - 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group
AU - ten Broek, Richard P.G.
AU - Krielen, Pepijn
AU - Di Saverio, Salomone
AU - Coccolini, Federico
AU - Biffl, Walter L.
AU - Ansaloni, Luca
AU - Velmahos, George C.
AU - Sartelli, Massimo
AU - Fraga, Gustavo P.
AU - Kelly, Michael D.
AU - Moore, Frederick A.
AU - Peitzman, Andrew B.
AU - Leppaniemi, Ari
AU - Moore, Ernest E.
AU - Jeekel, Johannes
AU - Kluger, Yoram
AU - Sugrue, Michael
AU - Balogh, Zsolt J.
AU - Bendinelli, Cino
AU - Civil, Ian
AU - Coimbra, Raul
AU - De Moya, Mark
AU - Ferrada, Paula
AU - Inaba, Kenji
AU - Ivatury, Rao
AU - Latifi, Rifat
AU - Kashuk, Jeffry L.
AU - Kirkpatrick, Andrew W.
AU - Maier, Ron
AU - Rizoli, Sandro
AU - Sakakushev, Boris
AU - Scalea, Thomas
AU - Søreide, Kjetil
AU - Weber, Dieter
AU - Wani, Imtiaz
AU - Abu-Zidan, Fikri M.
AU - De'Angelis, Nicola
AU - Piscioneri, Frank
AU - Galante, Joseph M.
AU - Catena, Fausto
AU - van Goor, Harry
N1 - Publisher Copyright:
© 2018 The Author(s).
PY - 2018/6/19
Y1 - 2018/6/19
N2 - Background: Adhesive small bowel obstruction (ASBO) is a common surgical emergency, causing high morbidity and even some mortality. The adhesions causing such bowel obstructions are typically the footprints of previous abdominal surgical procedures. The present paper presents a revised version of the Bologna guidelines to evidence-based diagnosis and treatment of ASBO. The working group has added paragraphs on prevention of ASBO and special patient groups. Methods: The guideline was written under the auspices of the World Society of Emergency Surgery by the ASBO working group. A systematic literature search was performed prior to the update of the guidelines to identify relevant new papers on epidemiology, diagnosis, and treatment of ASBO. Literature was critically appraised according to an evidence-based guideline development method. Final recommendations were approved by the workgroup, taking into account the level of evidence of the conclusion. Recommendations: Adhesion formation might be reduced by minimally invasive surgical techniques and the use of adhesion barriers. Non-operative treatment is effective in most patients with ASBO. Contraindications for non-operative treatment include peritonitis, strangulation, and ischemia. When the adhesive etiology of obstruction is unsure, or when contraindications for non-operative management might be present, CT is the diagnostic technique of choice. The principles of non-operative treatment are nil per os, naso-gastric, or long-tube decompression, and intravenous supplementation with fluids and electrolytes. When operative treatment is required, a laparoscopic approach may be beneficial for selected cases of simple ASBO. Younger patients have a higher lifetime risk for recurrent ASBO and might therefore benefit from application of adhesion barriers as both primary and secondary prevention. Discussion: This guideline presents recommendations that can be used by surgeons who treat patients with ASBO. Scientific evidence for some aspects of ASBO management is scarce, in particular aspects relating to special patient groups. Results of a randomized trial of laparoscopic versus open surgery for ASBO are awaited.
AB - Background: Adhesive small bowel obstruction (ASBO) is a common surgical emergency, causing high morbidity and even some mortality. The adhesions causing such bowel obstructions are typically the footprints of previous abdominal surgical procedures. The present paper presents a revised version of the Bologna guidelines to evidence-based diagnosis and treatment of ASBO. The working group has added paragraphs on prevention of ASBO and special patient groups. Methods: The guideline was written under the auspices of the World Society of Emergency Surgery by the ASBO working group. A systematic literature search was performed prior to the update of the guidelines to identify relevant new papers on epidemiology, diagnosis, and treatment of ASBO. Literature was critically appraised according to an evidence-based guideline development method. Final recommendations were approved by the workgroup, taking into account the level of evidence of the conclusion. Recommendations: Adhesion formation might be reduced by minimally invasive surgical techniques and the use of adhesion barriers. Non-operative treatment is effective in most patients with ASBO. Contraindications for non-operative treatment include peritonitis, strangulation, and ischemia. When the adhesive etiology of obstruction is unsure, or when contraindications for non-operative management might be present, CT is the diagnostic technique of choice. The principles of non-operative treatment are nil per os, naso-gastric, or long-tube decompression, and intravenous supplementation with fluids and electrolytes. When operative treatment is required, a laparoscopic approach may be beneficial for selected cases of simple ASBO. Younger patients have a higher lifetime risk for recurrent ASBO and might therefore benefit from application of adhesion barriers as both primary and secondary prevention. Discussion: This guideline presents recommendations that can be used by surgeons who treat patients with ASBO. Scientific evidence for some aspects of ASBO management is scarce, in particular aspects relating to special patient groups. Results of a randomized trial of laparoscopic versus open surgery for ASBO are awaited.
KW - Adhesions
KW - Laparoscopy
KW - Laparotomy
KW - Small bowel obstruction
KW - Surgery
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U2 - 10.1186/s13017-018-0185-2
DO - 10.1186/s13017-018-0185-2
M3 - Review article
C2 - 29946347
AN - SCOPUS:85048752330
SN - 1749-7922
VL - 13
JO - World Journal of Emergency Surgery
JF - World Journal of Emergency Surgery
IS - 1
M1 - 24
ER -