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Table 5 Overview of conclusions and recommendation

From: 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

Level A Adhesive small bowel obstruction is a leading cause of morbidity, deaths, and healthcare expenditures in emergency surgery.
A2 Scott 2016; NELA project team 2016
Level B Adhesive small bowel obstruction causes high morbidity, with average hospital stay of 8 days and 3% in-hospital mortality per episode. Recurrence of adhesive small bowel obstruction is high. Risk for adhesive small bowel obstruction may be somewhat lower after laparoscopic compared to open colorectal surgery, but that results could not be confirmed in randomized trials.
A2 ten Broek 2013; Yamada 2016; B Krielen 2016; Foster 2006
Level IB Laparoscopic surgery reduces adhesion formation and might reduce subsequent incidence of ASBO.
B Lundorff 1992; ten Broek 2013; Yamada 2016
Level IA 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.
A1 ten Broek 2014; A2 Fazio 2006; Park 2009; Kusunoki 205
Level IIC 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.
C Fevang 2002; Fevang 2004; Ten Broek 2013; Jeppesen 2016
Level IIB A trial of non-operative management can be continued safely for 72 h.
B Keenan 2014; Sakakibara 2007
Level IID Initial evaluation should be complemented with assessment of nutritional status and laboratory tests evaluating at least blood count, lactate, electrolytes, and BUN/Creat
Expert opinion
Level IIC Plain X-rays have only limited value in the work-up of patients with small bowel obstruction and are not recommended.
B Maglinte 1996
Level IB Optimal diagnostic work-up should include 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 reach the colon, this is indicative for resolution of the bowel obstruction.
A2 Ceresoli 2016; Branco 2010; Abbas 2005; B Goussous 2013; Zielinski 2011; Zielinski 2010; Daneshmat 1999; Makita 1999; Zalcman 2000
Level IIC Long trilumen naso-intestinal tubes are more efficacious than naso-gastric tubes in non-operative management, but require endoscopic placement.
A2 Chen2012
Level IIC Laparoscopic adhesiolyis might reduce morbidity in selected cases of ASBO that require surgery. Results of a randomized trial are awaited.
B Sajid 2016; Farinella 2009; Sallinen 2014
Level IIB Adhesion barriers reduce the risk of recurrence for ASBO following operative treatment.
A2 Catena 2012
Level IIC Younger patients, and pediatric patients in particular, have higher lifetime risk of developing adhesion-related complications and might therefore benefit most from adhesion prevention.
A1 ten Broek 2013; A2 Strik 2016; B Fredriksson 2016
Level C More research is needed to the impact of comorbidities in elderly patients on optimal management of adhesive small bowel obstruction. Patients with diabetes might require more early operative intervention.
B Karamanos 2016