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New Bologna guidelines for adhesive small bowel obstruction (ASBO)

New Bologna guidelines for adhesive small bowel obstruction (ASBO)

Adhesive small bowel obstruction (ASBO) is a common surgical emergency, causing high morbidity and in some cases may prove to be fatal. The current guideline which appears in the World Journal of Emergency Surgery is a revised version of the Bologna guidelines to evidence-based diagnosis and treatment of ASBO. The new guideline presents recommendations that can be used by surgeons who treat patients with ASBO.

Although adhesive small bowel obstruction is a common condition, the prevention and treatment are often characterized by surgeons’ personal preferences rather than standardized evidence-based protocols. There is a large amount of conflicting and low-quality evidence in publications regarding treatment of adhesive small bowel obstruction.

Therefore, the World Society of Emergency Surgery (WSES) working group on ASBO has developed evidence-based guidelines to support clinical decision making in the diagnosis and management of ASBO

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Key Recommendations:

  • Laparoscopic surgery reduces adhesion formation and might reduce subsequent incidence of ASBO.
  • Hyaluronate carboxymethylcellulose reduces adhesion formation and the risk of subsequent reoperations of adhesive SBO. The use of this barrier seems cost-effective in open colorectal surgery.
  • In the absence of signs that require emergent surgical exploration (i.e., peritonitis, strangulation, or bowel ischemia), non-operative management is the treatment strategy of choice.
  • A trial of non-operative management can be continued safely for 72 h.
  • Initial evaluation should be complemented with the assessment of nutritional status and laboratory tests evaluating at least blood count, lactate, electrolytes, and BUN/Creat
  • Plain X-rays have only limited value in the workup of patients with small bowel obstruction and are not recommended.
  • Optimal diagnostic workup should include a CT scan in the assessment and water-soluble oral contrast. In the absence of the need to perform immediate surgery, a follow-up abdominal X-ray should be made after 24 h. If the contrast has reached the colon, this is indicative of the resolution of the bowel obstruction.
  • Long trilumen Naso-intestinal tubes are more efficacious than nasogastric tubes in non-operative management but require endoscopic placement.
  • Adhesion barriers reduce the risk of recurrence for ASBO following operative treatment.
  • Younger patients, and pediatric patients, in particular, have a higher lifetime risk of developing adhesion-related complications and might, therefore, benefit most from adhesion prevention.
  • Patients with diabetes might require more early operative intervention.

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Source: With inputs from World Journal of Emergency Surgery

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