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World Journal of Emergency Surgery
Published in: World Journal of Emergency Surgery 1/2018

Open Access 01-12-2018 | Review

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

Authors: 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

Published in: World Journal of Emergency Surgery | Issue 1/2018

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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.
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Metadata
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
Authors
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
Publication date
01-12-2018
Publisher
BioMed Central
Published in
World Journal of Emergency Surgery / Issue 1/2018
Electronic ISSN: 1749-7922
DOI
https://doi.org/10.1186/s13017-018-0185-2

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