Parameter Predicting the Recurrence of Adhesive Small Bowel Obstruction in Patients Managed with a Long Tube

Sakakibara, Tetsuo; Harada, Akio; Ishikawa, Tadao; Komatsu, Yoshinao; Yaguchi, Toyohisa; Kodera, Yasuhiro; Nakao, Akimasa

doi:10.1007/s00268-006-0158-6

Cited by 22 publications

(30 citation statements)

References 40 publications

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“…The same authors in a further study identified 91 patients who recovered from ASBO with nonoperative management after long tube placement and divided them into two groups for follow-up: the recurrence group and the no-recurrence group [86] A significant difference was found in the number of previous ASBO admissions and the duration of long-tube placement (77 hours vs. 43 hours). By multivariate analysis, the duration of long-tube placement was an independent parameter predicting the recurrence of ASBO.…”

Section: Resultsmentioning

confidence: 99%

Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO): 2010 Evidence-Based Guidelines of the World Society of Emergency Surgery

et al. 2011

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BackgroundThere is no consensus on diagnosis and management of ASBO. Initial conservative management is usually safe, however proper timing for discontinuing non operative treatment is still controversial. Open surgery or laparoscopy are used without standardized indications.MethodsA panel of 13 international experts with interest and background in ASBO and peritoneal diseases, participated in a consensus conference during the 1st International Congress of the World Society of Emergency Surgery and 9th Peritoneum and Surgery Society meeting, in Bologna, July 1-3, 2010, for developing evidence-based recommendations for diagnosis and management of ASBO. Whenever was a lack of high-level evidence, the working group formulated guidelines by obtaining consensus.RecommendationsIn absence of signs of strangulation and history of persistent vomiting or combined CT scan signs (free fluid, mesenteric oedema, small bowel faeces sign, devascularized bowel) patients with partial ASBO can be managed safely with NOM and tube decompression (either with long or NG) should be attempted. These patients are good candidates for Water Soluble Contrast Medium (WSCM) with both diagnostic and therapeutic purposes. The appearance of water-soluble contrast in the colon on X-ray within 24 hours from administration predicts resolution. WSCM may be administered either orally or via NGT (50-150 ml) both immediately at admission or after an initial attempt of conservative treatment of 48 hours. The use of WSCM for ASBO 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 affect recurrence rates or recurrences needing surgery when compared to traditional conservative treatment.Open surgery is the preferred method for surgical treatment of strangulating ASBO as well as after failed conservative management. In selected patients and with appropriate skills, laparoscopic approach can be attempted using open access technique. Access in the left upper quadrant should be safe. Laparoscopic adhesiolysis should be attempted preferably in case of 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 can reduce incidence of adhesions. Icodextrin may reduce the risk of re-obstruction. HA cannot reduce need of surgery.

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Section: Resultsmentioning

confidence: 99%

Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO): 2010 Evidence-Based Guidelines of the World Society of Emergency Surgery

et al. 2011

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“…In our study, we saw no significant complications associated with contrast administration. Table 2 shows the variables related to the failure of nonoperative treatment and need for surgical intervention in ASBO [23,[26][27][28][29][30][31][32][33][34][35] . Parameters such as laparotomy or previous adhesive syndrome, vomiting at admission, serum CPK elevation, fever with leukocytosis >15.000/ mm 3 , NGT drainage greater than 500 ml on the third day of treatment, and progressive increase of bowel wall thickness by ultrasonographic exploration, have been associated with the need of laparotomy due to nonoperative treatment failure.…”

Section: Discussionmentioning

confidence: 99%

Adhesive Small Bowel Obstruction: Predictive Factors of Lack of Response in Conservative Management with Gastrografin

Bueno-Lledó¹,

Barber²,

Vaqué³

et al. 2015

Dig Surg

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Background: Gastrografin represents a useful tool in the diagnosis and management of adhesive small bowel obstruction (ASBO). The aim of this study is to identify variables with negative influence in nonoperative management with gastrografin. Methods: From August 2008 to March 2013, 223 consecutive patients with 235 episodes of ASBO were included and received gastrografin. A protocol for prospective data collection was developed. In order to explore factors related to the failure of nonoperative treatment, univariate and multivariate analysis were performed. Results: One hundred and ninety eight episodes responded to nonoperative treatment (84.2% of success) and 33 patients (15.8%) required surgical intervention. Only 3 patients of the gastrografin cohort with contrast in colon, required surgery. Predictive factors of failure of nonoperative management with gastrografin were patients aged above 65 (p = 0.01; OR 1.791, 95% CI 1.41-2.19), with a history of 2 or more previous laparotomies (p = 0.03; OR 2.91, 95% CI 2.19-3.71), and who had undergone previous abdominal surgery due to ASBO (p = 0.002; OR 1.381, 95% CI 1.10-1.79). Conclusion: Patient age, the number of previous laparotomies, and the fact that previous abdominal surgery was conducted due to ASBO are indicative of unsuccessful management with gastrografin.

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“…For challenging cases of ASBO, the long tube should be placed as soon as possible [24] more advisable by endoscopy, rather than by fluoroscopic guide [32]. …”

Section: Background Of Wses Guidelinesmentioning

confidence: 99%

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

Saverio¹,

Catena

Galati³

et al. 2013

World J Emerg Surg

210

136

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BackgroundIn 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.RecommendationsIn 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.

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Parameter Predicting the Recurrence of Adhesive Small Bowel Obstruction in Patients Managed with a Long Tube

Abstract: These results suggest that the duration of long-tube placement might serve as a parameter for predicting recurrence of ASBO in patients managed with a long tube.

Cited by 22 publications

References 40 publications

Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO): 2010 Evidence-Based Guidelines of the World Society of Emergency Surgery

Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO): 2010 Evidence-Based Guidelines of the World Society of Emergency Surgery

Adhesive Small Bowel Obstruction: Predictive Factors of Lack of Response in Conservative Management with Gastrografin

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

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