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.

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Abstract

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.

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Most cited references 94

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What is "quality of evidence" and why is it important to clinicians?

Gordon Guyatt, Andrew D Oxman, Regina Kunz … (2008)

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Going from evidence to recommendations.

Gordon Guyatt, Andrew D Oxman, Regina Kunz … (2008)

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Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis

Richard P G ten Broek, Yama Issa, Evert van Santbrink … (2013)

Objective To estimate the disease burden of the most important complications of postoperative abdominal adhesions: small bowel obstruction, difficulties at reoperation, infertility, and chronic pain. Design Systematic review and meta-analyses. Data sources Searches of PubMed, Embase, and Central, from January 1990 to December 2012, without restrictions to publication status or language. Study selection All types of studies reporting on the incidence of adhesion related complications were considered. Data extraction and analysis The primary outcome was the incidence of adhesive small bowel obstruction in patients with a history of abdominal surgery. Secondary outcomes were the incidence of small bowel obstruction by any cause, difference in operative time, enterotomy during adhesiolysis, and pregnancy rate after abdominal surgery. Subgroup and sensitivity analyses were done to study the robustness of the results. A random effects model was used to account for heterogeneity between studies. Results We identified 196 eligible papers. Heterogeneity was considerable for almost all meta-analyses. The origin of heterogeneity could not be explained by study design, study quality, publication date, anatomical site of operation, or operative technique. The incidence of small bowel obstruction by any cause after abdominal surgery was 9% (95% confidence interval 7% to 10%; I2=99%). the incidence of adhesive small bowel obstruction was 2% (2% to 3%; I2=93%); presence of adhesions was generally confirmed by emergent reoperation. In patients with a known cause of small bowel obstruction, adhesions were the single most common cause (56%, 49% to 64%; I2=96%). Operative time was prolonged by 15 minutes (95% confidence interval 9.3 to 21.1 minutes; I2=85%) in patients with previous surgery. Use of adhesiolysis resulted in a 6% (4% to 8%; I2=89%) incidence of iatrogenic bowel injury. The pregnancy rate after colorectal surgery in patients with inflammatory bowel disease was 50% (37% to 63%; I2=94%), which was significantly lower than the pregnancy rate in medically treated patients (82%, 70% to 94%; I2=97%). Conclusions This review provides detailed and systematically analysed knowledge of the disease burden of adhesions. Complications of postoperative adhesion formation are frequent, have a large negative effect on patients’ health, and increase workload in clinical practice. The quantitative effects should be interpreted with caution owing to large heterogeneity. Registration The review protocol was registered through PROSPERO (CRD42012003180).

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Author and article information

Journal

Journal ID (iso-abbrev): World J Emerg Surg

Title: World journal of emergency surgery : WJES

Publisher: Springer Science and Business Media LLC

ISSN (Electronic): 1749-7922

ISSN (Print): 1749-7922

Publication date (Electronic): 2018

Volume: 13

Affiliations

[1 ] 1Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.

[2 ] 39Department of Surgery, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.

[3 ] 2Addenbrooke's Hospital, Cambridge, UK.

[4 ] 3General Emergency and Trauma Surgery, Bufalini hospital, Cesena, Italy.

[5 ] 4Acute Care Surgery, The Queen's Medical Center, Honolulu, Hawaii USA.

[6 ] 5Department of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA USA.

[7 ] Department of Surgery, Macerata Hospital, Macerata, Italy.

[8 ] Faculdade de Ciências Médicas (FCM), Unicamp Campinas, São Paulo, Brazil.

[9 ] Albury Hospital, Albury, NSW Australia.

[10 ] 9University of Florida, Gainesville, USA.

[11 ] 10Department of Surgery, Trauma and Surgical Services, University of Pittsburgh School of Medicine, Pittsburgh, USA.

[12 ] Second Department of Surgery, Meilahti Hospital, Helsinki, Finland.

[13 ] 12Trauma Surgery, Denver Health, Denver, CO USA.

[14 ] 13Erasmus MC, Rotterdam, The Netherlands.

[15 ] Division of General Surgery Rambam Health Care Campus Haifa, Haifa, Israel.

[16 ] General Surgery Department, Letterkenny Hospital, Letterkenny, Ireland.

[17 ] 16Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW Australia.

[18 ] John Hunter Hospital, New Lambton Heights, New Zealand.

[19 ] 18Department of Vascular and Trauma Surgery, Auckland City Hospital, Auckland, New Zealand.

[20 ] 19Department of Surgery, UC San Diego Health System, San Diego, USA.

[21 ] Trauma, Acute Care Surgery Medical College of Wisconsin/Froedtert Trauma Center Milwaukee, Milwaukee, Wisconsin USA.

[22 ] 21Virginia Commonwealth University, Richmond, VA USA.

[23 ] 22Division of Trauma & Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA USA.

[24 ] 23Department of General Surgery, Westchester Medical Center, Westchester, NY USA.

[25 ] 24Department of General Surgery, Assuta Medical Centers, Tel Aviv, Israel.

[26 ] 25Department of Surgery, Foothills Medical Centre, Calgary, Canada.

[27 ] Department of Surgery, Harborview Medical Centre, Seattle, USA.

[28 ] 27Trauma & Acute Care Service, St Michael's Hospital, Toronto, ON Canada.

[29 ] 28Department of General Surgery, University of Medicine Plovdiv, Plovdiv, Bulgaria.

[30 ] 29R Adams Crowley Shock Trauma Center, University of Maryland, Baltimore, USA.

[31 ] 30Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.

[32 ] 31Department of Clinical Medicine, University of Bergen, Bergen, Norway.

[33 ] 32Department of General Surgery, Royal Perth Hospital, The University of Western Australia and The University of Newcastle, Perth, Australia.

[34 ] 33Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India.

[35 ] 34Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.

[36 ] 35Unit of Digestive Surgery, HPB Surgery and Liver Transplant, Henri Mondor Hospital, Créteil, France.

[37 ] 36Canberra Hospital, Canberra, Australia.

[38 ] 37Trauma and Acute Care Surgery and Surgical Critical Care Trauma, Department of Surgery, University of California, Davis, USA.

[39 ] Emergency and Trauma Surgery, Parma Maggiore hospital, Parma, Italy.

Article

Publisher Item ID: 185

DOI: 10.1186/s13017-018-0185-2

PMC ID: 6006983

PubMed ID: 29946347

SO-VID: 394918fa-874a-4e5c-983f-681ac4c1051a

History

Keywords: Surgery,Adhesions,Small bowel obstruction,Laparoscopy,Laparotomy

Data availability:

Keywords: Surgery, Adhesions, Small bowel obstruction, Laparoscopy, Laparotomy

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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.

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Most cited references 94

What is "quality of evidence" and why is it important to clinicians?

Going from evidence to recommendations.

Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis

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Cited by 108

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