• 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

      ten Broek, Richard P G; Krielen, Pepijn; Di Saverio, Salomone; Coccolini, Federico; Biffl, Walter L; Ansaloni, Luca; Velmahos, George C; Sartelli, Massimo; Fraga, Gustavo P; Kelly, Michael D; Moore, Frederick A; Peitzman, Andrew B; Leppaniemi, Ari; Moore, Ernest E; Jeekel, Johannes; Kluger, Yoram; Sugrue, Michael; Balogh, Zsolt J; Bendinelli, Cino; Civil, Ian; Coimbra, Raul; De Moya, Mark; Ferrada, Paula; Inaba, Kenji; Ivatury, Rao; Latifi, Rifat; Kashuk, Jeffry L; Kirkpatrick, Andrew W; Maier, Ron; Rizoli, Sandro; Sakakushev, Boris; Scalea, Thomas; Søreide, Kjetil; Weber, Dieter; Wani, Imtiaz; Abu-Zidan, Fikri M; De’Angelis, Nicola; Piscioneri, Frank; Galante, Joseph M; Catena, Fausto; van Goor, Harry (2018-06-19)
      Abstract Background 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. Methods The 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. Recommendations Adhesion 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. Discussion This 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.
    • Management of intra-abdominal infections: recommendations by the WSES 2016 consensus conference

      Sartelli, Massimo; Catena, Fausto; Abu-Zidan, Fikri M; Ansaloni, Luca; Biffl, Walter L; Boermeester, Marja A; Ceresoli, Marco; Chiara, Osvaldo; Coccolini, Federico; De Waele, Jan J; Di Saverio, Salomone; Eckmann, Christian; Fraga, Gustavo P; Giannella, Maddalena; Girardis, Massimo; Griffiths, Ewen A; Kashuk, Jeffry; Kirkpatrick, Andrew W; Khokha, Vladimir; Kluger, Yoram; Labricciosa, Francesco M; Leppaniemi, Ari; Maier, Ronald V; May, Addison K; Malangoni, Mark; Martin-Loeches, Ignacio; Mazuski, John; Montravers, Philippe; Peitzman, Andrew; Pereira, Bruno M; Reis, Tarcisio; Sakakushev, Boris; Sganga, Gabriele; Soreide, Kjetil; Sugrue, Michael; Ulrych, Jan; Vincent, Jean-Louis; Viale, Pierluigi; Moore, Ernest E (2017-05-04)
      Abstract This paper reports on the consensus conference on the management of intra-abdominal infections (IAIs) which was held on July 23, 2016, in Dublin, Ireland, as a part of the annual World Society of Emergency Surgery (WSES) meeting. This document covers all aspects of the management of IAIs. The Grading of Recommendations Assessment, Development and Evaluation recommendation is used, and this document represents the executive summary of the consensus conference findings.
    • The open abdomen in trauma and non-trauma patients: WSES guidelines

      Coccolini, Federico; Roberts, Derek; Ansaloni, Luca; Ivatury, Rao; Gamberini, Emiliano; Kluger, Yoram; Moore, Ernest E; Coimbra, Raul; Kirkpatrick, Andrew W; Pereira, Bruno M; Montori, Giulia; Ceresoli, Marco; Abu-Zidan, Fikri M; Sartelli, Massimo; Velmahos, George; Fraga, Gustavo P; Leppaniemi, Ari; Tolonen, Matti; Galante, Joseph; Razek, Tarek; Maier, Ron; Bala, Miklosh; Sakakushev, Boris; Khokha, Vladimir; Malbrain, Manu; Agnoletti, Vanni; Peitzman, Andrew; Demetrashvili, Zaza; Sugrue, Michael; Di Saverio, Salomone; Martzi, Ingo; Soreide, Kjetil; Biffl, Walter; Ferrada, Paula; Parry, Neil; Montravers, Philippe; Melotti, Rita M; Salvetti, Francesco; Valetti, Tino M; Scalea, Thomas; Chiara, Osvaldo; Cimbanassi, Stefania; Kashuk, Jeffry L; Larrea, Martha; Hernandez, Juan A M; Lin, Heng-Fu; Chirica, Mircea; Arvieux, Catherine; Bing, Camilla; Horer, Tal; De Simone, Belinda; Masiakos, Peter; Reva, Viktor; DeAngelis, Nicola; Kike, Kaoru; Balogh, Zsolt J; Fugazzola, Paola; Tomasoni, Matteo; Latifi, Rifat; Naidoo, Noel; Weber, Dieter; Handolin, Lauri; Inaba, Kenji; Hecker, Andreas; Kuo-Ching, Yuan; Ordoñez, Carlos A; Rizoli, Sandro; Gomes, Carlos A; De Moya, Marc; Wani, Imtiaz; Mefire, Alain C; Boffard, Ken; Napolitano, Lena; Catena, Fausto (2018-02-02)
      Abstract Damage control resuscitation may lead to postoperative intra-abdominal hypertension or abdominal compartment syndrome. These conditions may result in a vicious, self-perpetuating cycle leading to severe physiologic derangements and multiorgan failure unless interrupted by abdominal (surgical or other) decompression. Further, in some clinical situations, the abdomen cannot be closed due to the visceral edema, the inability to control the compelling source of infection or the necessity to re-explore (as a “planned second-look” laparotomy) or complete previously initiated damage control procedures or in cases of abdominal wall disruption. The open abdomen in trauma and non-trauma patients has been proposed to be effective in preventing or treating deranged physiology in patients with severe injuries or critical illness when no other perceived options exist. Its use, however, remains controversial as it is resource consuming and represents a non-anatomic situation with the potential for severe adverse effects. Its use, therefore, should only be considered in patients who would most benefit from it. Abdominal fascia-to-fascia closure should be done as soon as the patient can physiologically tolerate it. All precautions to minimize complications should be implemented.
    • The role of open abdomen in non-trauma patient: WSES Consensus Paper

      Coccolini, Federico; Montori, Giulia; Ceresoli, Marco; Catena, Fausto; Moore, Ernest E; Ivatury, Rao; Biffl, Walter; Peitzman, Andrew; Coimbra, Raul; Rizoli, Sandro; Kluger, Yoram; Abu-Zidan, Fikri M; Sartelli, Massimo; De Moya, Marc; Velmahos, George; Fraga, Gustavo P; Pereira, Bruno M; Leppaniemi, Ari; Boermeester, Marja A; Kirkpatrick, Andrew W; Maier, Ron; Bala, Miklosh; Sakakushev, Boris; Khokha, Vladimir; Malbrain, Manu; Agnoletti, Vanni; Martin-Loeches, Ignacio; Sugrue, Michael; Di Saverio, Salomone; Griffiths, Ewen; Soreide, Kjetil; Mazuski, John E; May, Addison K; Montravers, Philippe; Melotti, Rita M; Pisano, Michele; Salvetti, Francesco; Marchesi, Gianmariano; Valetti, Tino M; Scalea, Thomas; Chiara, Osvaldo; Kashuk, Jeffry L; Ansaloni, Luca (2017-08-14)
      Abstract The open abdomen (OA) is defined as intentional decision to leave the fascial edges of the abdomen un-approximated after laparotomy (laparostomy). The abdominal contents are potentially exposed and therefore must be protected with a temporary coverage, which is referred to as temporal abdominal closure (TAC). OA use remains widely debated with many specific details deserving detailed assessment and clarification. To date, in patients with intra-abdominal emergencies, the OA has not been formally endorsed for routine utilization; although, utilization is seemingly increasing. Therefore, the World Society of Emergency Surgery (WSES), Abdominal Compartment Society (WSACS) and the Donegal Research Academy united a worldwide group of experts in an international consensus conference to review and thereafter propose the basis for evidence-directed utilization of OA management in non-trauma emergency surgery and critically ill patients. In addition to utilization recommendations, questions with insufficient evidence urgently requiring future study were identified.