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Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group

Di Saverio, S and Coccolini, F and Galati, M and Smerieri, N and Biffl, WL and Ansaloni, L and Tugnoli, G and Velmahos, GC and Sartelli, M and Bendinelli, C and Fraga, GP and Kelly, MD and Moore, FA and Mandalà, V and Mandalà, S and Masetti, M and Jovine, E and Pinna, AD and Peitzman, AB and Leppaniemi, A and Sugarbaker, PH and Goor, HV and Moore, EE and Jeekel, J and Catena, F (2013) Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World Journal of Emergency Surgery, 8 (1).

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Abstract

Background: In 2013 Guidelines on diagnosis and management of ASBO have been revised and updated by the WSES Working Group on ASBO to develop current evidence-based algorithms and focus indications and safety of conservative treatment, timing of surgery and indications for laparoscopy.Recommendations: In absence of signs of strangulation and history of persistent vomiting or combined CT-scan signs (free fluid, mesenteric edema, small-bowel feces sign, devascularization) patients with partial ASBO can be managed safely with NOM and tube decompression should be attempted. These patients are good candidates for Water-Soluble-Contrast-Medium (WSCM) with both diagnostic and therapeutic purposes. The radiologic appearance of WSCM in the colon within 24 hours from administration predicts resolution. WSCM maybe administered either orally or via NGT both immediately at admission or after failed conservative treatment for 48 hours. The use of WSCM is safe and reduces need for surgery, time to resolution and hospital stay.NOM, in absence of signs of strangulation or peritonitis, can be prolonged up to 72 hours. After 72 hours of NOM without resolution, surgery is recommended.Patients treated non-operatively have shorter hospital stay, but higher recurrence rate and shorter time to re-admission, although the risk of new surgically treated episodes of ASBO is unchanged. Risk factors for recurrences are age <40 years and matted adhesions. WSCM does not decrease recurrence rates or recurrences needing surgery.Open surgery is often used for strangulating ASBO as well as after failed conservative management. In selected patients and with appropriate skills, laparoscopic approach is advisable using open access technique. Access in left upper quadrant or left flank is the safest and only completely obstructing adhesions should be identified and lysed with cold scissors. Laparoscopic adhesiolysis should be attempted preferably if first episode of SBO and/or anticipated single band. A low threshold for open conversion should be maintained.Peritoneal adhesions should be prevented. Hyaluronic acid-carboxycellulose membrane and icodextrin decrease incidence of adhesions. Icodextrin may reduce the risk of re-obstruction. HA cannot reduce need of surgery.Adhesions quantification and scoring maybe useful for achieving standardized assessment of adhesions severity and for further research in diagnosis and treatment of ASBO. © 2013 Di Saverio et al.; licensee BioMed Central Ltd.

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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Di Saverio, S
Coccolini, F
Galati, M
Smerieri, N
Biffl, WL
Ansaloni, L
Tugnoli, G
Velmahos, GC
Sartelli, M
Bendinelli, C
Fraga, GP
Kelly, MD
Moore, FA
Mandalà, V
Mandalà, S
Masetti, M
Jovine, E
Pinna, AD
Peitzman, ABpeitzman@pitt.eduPEITZMAN
Leppaniemi, A
Sugarbaker, PH
Goor, HV
Moore, EE
Jeekel, J
Catena, F
Date: 10 October 2013
Date Type: Publication
Journal or Publication Title: World Journal of Emergency Surgery
Volume: 8
Number: 1
DOI or Unique Handle: 10.1186/1749-7922-8-42
Schools and Programs: School of Medicine > Surgery
Refereed: Yes
Article Type: Review
Date Deposited: 02 Dec 2016 16:08
Last Modified: 05 Feb 2019 03:55
URI: http://d-scholarship.pitt.edu/id/eprint/29672

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