Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group
Abstract 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 versi...
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2018-06-01
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| Series: | World Journal of Emergency Surgery |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13017-018-0185-2 |
| _version_ | 1828381318848708608 |
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| author | Richard P. G. ten Broek Pepijn Krielen Salomone Di Saverio Federico Coccolini Walter L. Biffl Luca Ansaloni George C. Velmahos Massimo Sartelli Gustavo P. Fraga Michael D. Kelly Frederick A. Moore Andrew B. Peitzman Ari Leppaniemi Ernest E. Moore Johannes Jeekel Yoram Kluger Michael Sugrue Zsolt J. Balogh Cino Bendinelli Ian Civil Raul Coimbra Mark De Moya Paula Ferrada Kenji Inaba Rao Ivatury Rifat Latifi Jeffry L. Kashuk Andrew W. Kirkpatrick Ron Maier Sandro Rizoli Boris Sakakushev Thomas Scalea Kjetil Søreide Dieter Weber Imtiaz Wani Fikri M. Abu-Zidan Nicola De’Angelis Frank Piscioneri Joseph M. Galante Fausto Catena Harry van Goor |
| author_facet | Richard P. G. ten Broek Pepijn Krielen Salomone Di Saverio Federico Coccolini Walter L. Biffl Luca Ansaloni George C. Velmahos Massimo Sartelli Gustavo P. Fraga Michael D. Kelly Frederick A. Moore Andrew B. Peitzman Ari Leppaniemi Ernest E. Moore Johannes Jeekel Yoram Kluger Michael Sugrue Zsolt J. Balogh Cino Bendinelli Ian Civil Raul Coimbra Mark De Moya Paula Ferrada Kenji Inaba Rao Ivatury Rifat Latifi Jeffry L. Kashuk Andrew W. Kirkpatrick Ron Maier Sandro Rizoli Boris Sakakushev Thomas Scalea Kjetil Søreide Dieter Weber Imtiaz Wani Fikri M. Abu-Zidan Nicola De’Angelis Frank Piscioneri Joseph M. Galante Fausto Catena Harry van Goor |
| author_sort | Richard P. G. ten Broek |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-12-10T04:13:32Z |
| format | Article |
| id | doaj.art-e03d37d269ed482395dc80610caa7f5c |
| institution | Directory Open Access Journal |
| issn | 1749-7922 |
| language | English |
| last_indexed | 2024-12-10T04:13:32Z |
| publishDate | 2018-06-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Emergency Surgery |
| spelling | doaj.art-e03d37d269ed482395dc80610caa7f5c2022-12-22T02:02:40ZengBMCWorld Journal of Emergency Surgery1749-79222018-06-0113111310.1186/s13017-018-0185-2Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working groupRichard P. G. ten Broek0Pepijn Krielen1Salomone Di Saverio2Federico Coccolini3Walter L. Biffl4Luca Ansaloni5George C. Velmahos6Massimo Sartelli7Gustavo P. Fraga8Michael D. Kelly9Frederick A. Moore10Andrew B. Peitzman11Ari Leppaniemi12Ernest E. Moore13Johannes Jeekel14Yoram KlugerMichael Sugrue15Zsolt J. Balogh16Cino Bendinelli17Ian Civil18Raul Coimbra19Mark De Moya20Paula Ferrada21Kenji Inaba22Rao Ivatury23Rifat Latifi24Jeffry L. Kashuk25Andrew W. Kirkpatrick26Ron Maier27Sandro Rizoli28Boris Sakakushev29Thomas Scalea30Kjetil Søreide31Dieter Weber32Imtiaz Wani33Fikri M. Abu-Zidan34Nicola De’Angelis35Frank Piscioneri36Joseph M. Galante37Fausto Catena38Harry van Goor39Department of Surgery, Radboud University Medical CenterDepartment of Surgery, Radboud University Medical CenterAddenbrooke’s HospitalGeneral Emergency and Trauma Surgery, Bufalini hospitalAcute Care Surgery, The Queen’s Medical CenterGeneral Emergency and Trauma Surgery, Bufalini hospitalDepartment of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General HospitalDepartment of Surgery, Macerata HospitalFaculdade de Ciências Médicas (FCM), Unicamp CampinasAlbury HospitalUniversity of FloridaDepartment of Surgery, Trauma and Surgical Services, University of Pittsburgh School of MedicineSecond Department of Surgery, Meilahti HospitalTrauma Surgery, Denver HealthErasmus MCGeneral Surgery Department, Letterkenny HospitalDepartment of Traumatology, John Hunter Hospital and University of NewcastleJohn Hunter HospitalDepartment of Vascular and Trauma Surgery, Auckland City HospitalDepartment of Surgery, UC San Diego Health SystemTrauma, Acute Care Surgery Medical College of Wisconsin/Froedtert Trauma Center MilwaukeeVirginia Commonwealth UniversityDivision of Trauma & Critical Care, LAC+USC Medical Center, University of Southern CaliforniaVirginia Commonwealth UniversityDepartment of General Surgery, Westchester Medical CenterDepartment of General Surgery, Assuta Medical CentersDepartment of Surgery, Foothills Medical CentreDepartment of Surgery, Harborview Medical CentreTrauma & Acute Care Service, St Michael’s HospitalDepartment of General Surgery, University of Medicine PlovdivR Adams Crowley Shock Trauma Center, University of MarylandDepartment of Gastrointestinal Surgery, Stavanger University HospitalDepartment of General Surgery, Royal Perth Hospital, The University of Western Australia and The University of NewcastleDepartment of Surgery, Sheri-Kashmir Institute of Medical SciencesDepartment of Surgery, College of Medicine and Health Sciences, UAE UniversityUnit of Digestive Surgery, HPB Surgery and Liver Transplant, Henri Mondor HospitalCanberra HospitalTrauma and Acute Care Surgery and Surgical Critical Care Trauma, Department of Surgery, University of CaliforniaEmergency and Trauma Surgery, Parma Maggiore hospitalDepartment of Surgery, Radboud University Medical CenterAbstract 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.http://link.springer.com/article/10.1186/s13017-018-0185-2Small bowel obstructionAdhesionsSurgeryLaparoscopyLaparotomy |
| spellingShingle | Richard P. G. ten Broek Pepijn Krielen Salomone Di Saverio Federico Coccolini Walter L. Biffl Luca Ansaloni George C. Velmahos Massimo Sartelli Gustavo P. Fraga Michael D. Kelly Frederick A. Moore Andrew B. Peitzman Ari Leppaniemi Ernest E. Moore Johannes Jeekel Yoram Kluger Michael Sugrue Zsolt J. Balogh Cino Bendinelli Ian Civil Raul Coimbra Mark De Moya Paula Ferrada Kenji Inaba Rao Ivatury Rifat Latifi Jeffry L. Kashuk Andrew W. Kirkpatrick Ron Maier Sandro Rizoli Boris Sakakushev Thomas Scalea Kjetil Søreide Dieter Weber Imtiaz Wani Fikri M. Abu-Zidan Nicola De’Angelis Frank Piscioneri Joseph M. Galante Fausto Catena Harry van Goor Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group World Journal of Emergency Surgery Small bowel obstruction Adhesions Surgery Laparoscopy Laparotomy |
| title | Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group |
| title_full | Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group |
| title_fullStr | Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group |
| title_full_unstemmed | Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group |
| title_short | Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group |
| title_sort | bologna guidelines for diagnosis and management of adhesive small bowel obstruction asbo 2017 update of the evidence based guidelines from the world society of emergency surgery asbo working group |
| topic | Small bowel obstruction Adhesions Surgery Laparoscopy Laparotomy |
| url | http://link.springer.com/article/10.1186/s13017-018-0185-2 |
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