Abstract
BackgroundAdhesive 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.MethodsThe 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.RecommendationsAdhesion 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.DiscussionThis 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.
Highlights
Adhesive small bowel obstruction (ASBO) is a common surgical emergency, causing high morbidity and even some mortality
Recurrence of ASBO is frequent; 12% of non-operatively treated patients are readmitted within 1 year, rising to 20% after 5 years
Solid barrier most suitable for open surgery laparoscopic placement has been described Studies in both general surgery and gynecological procedures Reduces adhesion formation, as well as the risk for reoperations for adhesive small bowel obstruction
Summary
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. Adhesive small bowel obstruction (ASBO) is one of the leading causes of surgical emergencies and in particular of surgical emergencies that require an emergent operations [1–4]. Adhesive small bowel obstruction was the most common diagnosis for both the top 2 (small bowel resection) and top 5 (adhesiolysis) procedures [3]. Post-operative adhesions are the leading cause of small bowel obstructions, accounting for 60% of cases [1]. Between 20 and 30% of patients with adhesive small bowel obstruction require operative treatment [1, 9–11]. Associated costs in a Dutch study in 2016 were estimated at €16,305 for surgical and €2227 for non-operative treatment [12]
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