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

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 CivilRaul 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

Research output: Contribution to journalReview article

15 Citations (Scopus)

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.

Original languageEnglish (US)
Article number24
JournalWorld Journal of Emergency Surgery
Volume13
Issue number1
DOIs
StatePublished - Jun 19 2018

Fingerprint

Adhesives
Emergencies
Guidelines
Therapeutics
Primary Prevention
Secondary Prevention
Decompression
Peritonitis
Electrolytes
Stomach
Epidemiology
Ischemia
Morbidity
Mortality

Keywords

  • Adhesions
  • Laparoscopy
  • Laparotomy
  • Small bowel obstruction
  • Surgery

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine

Cite this

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. / ten Broek, Richard P.G.; Krielen, Pepijn; Di Saverio, Salomone; Coccolini, Federico; Biffl, Walter L.; Ansaloni, Luca; Velmahos, George C.; Sartelli, Massimo; Fraga, Gustavo P.; Kelly, Michael D.; Moore, Frederick A.; Peitzman, Andrew B.; Leppaniemi, Ari; Moore, Ernest E.; Jeekel, Johannes; Kluger, Yoram; Sugrue, Michael; Balogh, Zsolt J.; Bendinelli, Cino; Civil, Ian; Coimbra, Raul; De Moya, Mark; Ferrada, Paula; Inaba, Kenji; Ivatury, Rao; Latifi, Rifat; Kashuk, Jeffry L.; Kirkpatrick, Andrew W.; Maier, Ron; Rizoli, Sandro; Sakakushev, Boris; Scalea, Thomas; Søreide, Kjetil; Weber, Dieter; Wani, Imtiaz; Abu-Zidan, Fikri M.; De'Angelis, Nicola; Piscioneri, Frank; Galante, Joseph M; Catena, Fausto; van Goor, Harry.

In: World Journal of Emergency Surgery, Vol. 13, No. 1, 24, 19.06.2018.

Research output: Contribution to journalReview article

ten Broek, RPG, Krielen, P, Di Saverio, S, Coccolini, F, Biffl, WL, Ansaloni, L, Velmahos, GC, Sartelli, M, Fraga, GP, Kelly, MD, Moore, FA, Peitzman, AB, Leppaniemi, A, Moore, EE, Jeekel, J, Kluger, Y, Sugrue, M, Balogh, ZJ, Bendinelli, C, Civil, I, Coimbra, R, De Moya, M, Ferrada, P, Inaba, K, Ivatury, R, Latifi, R, Kashuk, JL, Kirkpatrick, AW, Maier, R, Rizoli, S, Sakakushev, B, Scalea, T, Søreide, K, Weber, D, Wani, I, Abu-Zidan, FM, De'Angelis, N, Piscioneri, F, Galante, JM, Catena, F & van Goor, H 2018, '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, vol. 13, no. 1, 24. https://doi.org/10.1186/s13017-018-0185-2
ten Broek, Richard P.G. ; Krielen, Pepijn ; Di Saverio, Salomone ; Coccolini, Federico ; Biffl, Walter L. ; Ansaloni, Luca ; Velmahos, George C. ; Sartelli, Massimo ; Fraga, Gustavo P. ; Kelly, Michael D. ; Moore, Frederick A. ; Peitzman, Andrew B. ; Leppaniemi, Ari ; Moore, Ernest E. ; Jeekel, Johannes ; Kluger, Yoram ; Sugrue, Michael ; Balogh, Zsolt J. ; Bendinelli, Cino ; Civil, Ian ; Coimbra, Raul ; De Moya, Mark ; Ferrada, Paula ; Inaba, Kenji ; Ivatury, Rao ; Latifi, Rifat ; Kashuk, Jeffry L. ; Kirkpatrick, Andrew W. ; Maier, Ron ; Rizoli, Sandro ; Sakakushev, Boris ; Scalea, Thomas ; Søreide, Kjetil ; Weber, Dieter ; Wani, Imtiaz ; Abu-Zidan, Fikri M. ; De'Angelis, Nicola ; Piscioneri, Frank ; Galante, Joseph M ; Catena, Fausto ; van Goor, Harry. / 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. In: World Journal of Emergency Surgery. 2018 ; Vol. 13, No. 1.
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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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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

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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