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Rashid A, Kumar M, Lee MJ. A systematic review of participant descriptors reported in studies of adhesive small bowel obstruction. Colorectal Dis 2024; 26:851-870. [PMID: 38609340 DOI: 10.1111/codi.16986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/05/2023] [Accepted: 11/05/2023] [Indexed: 04/14/2024]
Abstract
AIM Reporting of participant descriptors in studies of adhesive small bowel obstruction (ASBO) can help identify characteristics associated with favourable outcomes and allow comparison with other studies and real-world clinical populations. The aim was to identify the pattern of participant descriptors reported in studies assessing interventions for ASBO. METHOD This systematic review was registered with PROSPERO (CRD42021281031) and reported in line with the PRISMA checklist. Systematic searches of Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were undertaken to identify studies assessing operative and non-operative interventions for adults with ASBO. Studies were dual screened for inclusion. Descriptors were categorised into conceptual domains by the research team. RESULTS Searches identified 2648 studies, of which 73 were included. A total of 156 unique descriptors were identified. On average, studies reported 12 descriptors. The most frequently reported descriptors were sex, age, SBO aetiology, history of abdominal surgery, BMI and ASA classification. The highest number of descriptors in a single study was 34, compared to the lowest number of descriptors which was one. Pathway factors were the least frequently described domain. Overall, 37 descriptors were reported in just one study. CONCLUSION There is a lack of consistency in participant descriptors reported in studies of SBO. Furthermore, a significant proportion of the descriptors were used infrequently. This makes it challenging to assess whether study participants are representative of the wider population. Further work is required to develop a Core Descriptor Set to standardise the reporting of patient characteristics and reduce heterogeneity between studies.
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Affiliation(s)
- Adil Rashid
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, UK
- Academic Directorate of General Surgery, Sheffield Teaching Hospitals NHS FT, Sheffield, UK
| | - Mithun Kumar
- Department of General Surgery, University Hospital Coventry and Warwickshire, Coventry, UK
| | - Matthew J Lee
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, UK
- Academic Directorate of General Surgery, Sheffield Teaching Hospitals NHS FT, Sheffield, UK
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Siebert T, Moersdorf G, Colberg T. Laparoscopic application of sodium hyaluronate-carboxymethylcellulose barrier in abdominopelvic surgery: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Systematic Review Protocols-compliant systematic review and meta-analysis. Surgery 2024; 175:1358-1367. [PMID: 38429164 DOI: 10.1016/j.surg.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 01/03/2024] [Accepted: 01/12/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND We aimed to evaluate the incidence of postoperative adhesion formation and adhesion-related consequences (eg, bowel obstruction) after placement of a sodium hyaluronate-carboxymethylcellulose adhesion barrier after laparoscopic abdominopelvic surgery. METHODS In this systematic review and meta-analysis, we searched the Medical Literature Analysis and Retrieval System Online and Embase via Ovid, Cochrane Central Register of Controlled Trials, ScienceDirect, BIOSIS Previews, Cumulative Index to Nursing and Allied Health Literature, and Clinical Trial Registries. A manual search (eg, Google Scholar and professional association websites) was also conducted to supplement the electronic database results. Two reviewers independently identified relevant studies based on inclusion and exclusion criteria and extracted data. RESULTS A total of 28 studies were included in the systematic qualitative review. Three of the 28 studies included had comparable outcome measures, interventions, and control groups, allowing the pooling of study data. A total of 938 patients (490 patients in the sodium hyaluronate-carboxymethylcellulose barrier group and 448 in the no adhesion barrier group) from these 3 studies were included in the meta-analyses, which found the incidence of bowel obstruction was significantly lower (65% risk reduction) in the sodium hyaluronate-carboxymethylcellulose barrier group compared with the control group (relative risk = 0.35; 95% confidence interval, 0.19-0.63; P = .005) with extremely low heterogeneity between studies (I2 = 0; P = .41). The placement of sodium hyaluronate-carboxymethylcellulose barrier laparoscopically did not create new safety signals nor did it increase the incidence of adverse events. CONCLUSION Our meta-analysis found that laparoscopic application of a sodium hyaluronate-carboxymethylcellulose barrier in abdominopelvic surgery reduces the risk of bowel obstruction where applied during the early postoperative phase.
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Affiliation(s)
- Terri Siebert
- Medical Affairs, Baxter Healthcare Corporation, Deerfield, IL.
| | | | - Torben Colberg
- Medical Affairs, Baxter Healthcare Corporation, Deerfield, IL
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Wang Z, Sun B, Yu Y, Liu J, Li D, Lu Y, Liu R. A novel nomogram integrating body composition and inflammatory-nutritional markers for predicting postoperative complications in patients with adhesive small bowel obstruction. Front Nutr 2024; 11:1345570. [PMID: 38706567 PMCID: PMC11066162 DOI: 10.3389/fnut.2024.1345570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/08/2024] [Indexed: 05/07/2024] Open
Abstract
Background Postoperative complications in adhesive small bowel obstruction (ASBO) significantly escalate healthcare costs and prolong hospital stays. This study endeavors to construct a nomogram that synergizes computed tomography (CT) body composition data with inflammatory-nutritional markers to forecast postoperative complications in ASBO. Methods The study's internal cohort consisted of 190 ASBO patients recruited from October 2017 to November 2021, subsequently partitioned into training (n = 133) and internal validation (n = 57) groups at a 7:3 ratio. An additional external cohort comprised 52 patients. Body composition assessments were conducted at the third lumbar vertebral level utilizing CT images. Baseline characteristics alongside systemic inflammatory responses were meticulously documented. Through univariable and multivariable regression analyses, risk factors pertinent to postoperative complications were identified, culminating in the creation of a predictive nomogram. The nomogram's precision was appraised using the concordance index (C-index) and the area under the receiver operating characteristic (ROC) curve. Results Postoperative complications were observed in 65 (48.87%), 26 (45.61%), and 22 (42.31%) patients across the three cohorts, respectively. Multivariate analysis revealed that nutrition risk score (NRS), intestinal strangulation, skeletal muscle index (SMI), subcutaneous fat index (SFI), neutrophil-lymphocyte ratio (NLR), and lymphocyte-monocyte ratio (LMR) were independently predictive of postoperative complications. These preoperative indicators were integral to the nomogram's formulation. The model, amalgamating body composition and inflammatory-nutritional indices, demonstrated superior performance: the internal training set exhibited a 0.878 AUC (95% CI, 0.802-0.954), 0.755 accuracy, and 0.625 sensitivity; the internal validation set displayed a 0.831 AUC (95% CI, 0.675-0.986), 0.818 accuracy, and 0.812 sensitivity. In the external cohort, the model yielded an AUC of 0.886 (95% CI, 0.799-0.974), 0.808 accuracy, and 0.909 sensitivity. Calibration curves affirmed a strong concordance between predicted outcomes and actual events. Decision curve analysis substantiated that the model could confer benefits on patients with ASBO. Conclusion A rigorously developed and validated nomogram that incorporates body composition and inflammatory-nutritional indices proves to be a valuable tool for anticipating postoperative complications in ASBO patients, thus facilitating enhanced clinical decision-making.
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Affiliation(s)
- Zhibo Wang
- Department of Gastroenterological Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Baoying Sun
- Neurology Department, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yimiao Yu
- Department of Radiation Oncology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jingnong Liu
- Department of Gastroenterological Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Duo Li
- Institute of Nutrition and Health, College of Public Health, Qingdao University, Qingdao, China
| | - Yun Lu
- Department of Gastroenterological Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ruiqing Liu
- Department of Gastroenterological Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
- Institute of Nutrition and Health, College of Public Health, Qingdao University, Qingdao, China
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Morelli M, Strambi S, Cremonini C, Musetti S, Tonerini M, Coccolini F, Chiarugi M, Tartaglia D. Adhesive small bowel obstruction: predictive factors of laparoscopic failure. Updates Surg 2024; 76:705-712. [PMID: 38151681 DOI: 10.1007/s13304-023-01725-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/01/2023] [Indexed: 12/29/2023]
Abstract
The adoption of laparoscopy for the management of adhesive small bowel obstruction (ASBO) patients is debated. The laparoscopic approach has been associated with a considerable conversion-to-open rate. Nonetheless, reliable predictors of conversion are still unclear. The present study aimed to identify factors associated with conversion to open in ASBO patients who underwent laparoscopic surgery. Patients who underwent laparoscopic surgery for ASBO and were admitted to our unit between December 2014 and October 2022 were retrospectively evaluated. The patients were categorized into two groups: patients who underwent complete laparoscopy approach (Group 1) and patients converted to open technique (Group 2). Demographic, clinical, and radiological features, intraoperative findings, and postoperative outcomes were compared. A total of 168 patients were enrolled: 100 patients (59.5%) were included in Group 1, and 68 patients (40.5%) were included in Group 2. The rate of ischemia (p = 0.023), surgical complications (p = 0.001), operative time (p < 0.0001), days of nasogastric tube maintenance (p < 0.0001), time to canalization (p < 0.0001), and length of hospital stay (p < 0.0001) were significantly higher in Group 2 than Group 1. Following univariate analysis, the presence of feces signs (p = 0.044) and high mean radiodensity of intraperitoneal free fluid (p = 0.031) were significantly associated with Group 2 compared with Group 1. Following multivariate analysis, the feces sign was a significant predictive factor of conversion (OR 1.965 [IC 95%]; p = 0.046). Laparoscopic treatment is a safe and effective approach in patients affected by ASBO. The feces sign may be a predictive factor of conversion and could guide the surgeon in selecting the appropriate management of patients affected by ASBO.
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Affiliation(s)
- Marta Morelli
- General and Emergency Unit and Trauma Center, New Santa Chiara Hospital, University of Pisa, Via Paradisa, 2, 56021, Pisa, Italy
| | - Silvia Strambi
- General and Emergency Unit and Trauma Center, New Santa Chiara Hospital, University of Pisa, Via Paradisa, 2, 56021, Pisa, Italy
| | - Camilla Cremonini
- General and Emergency Unit and Trauma Center, New Santa Chiara Hospital, University of Pisa, Via Paradisa, 2, 56021, Pisa, Italy
| | - Serena Musetti
- General and Emergency Unit and Trauma Center, New Santa Chiara Hospital, University of Pisa, Via Paradisa, 2, 56021, Pisa, Italy
| | - Michele Tonerini
- Radio-Diagnostic Unit, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Federico Coccolini
- General and Emergency Unit and Trauma Center, New Santa Chiara Hospital, University of Pisa, Via Paradisa, 2, 56021, Pisa, Italy
| | - Massimo Chiarugi
- General and Emergency Unit and Trauma Center, New Santa Chiara Hospital, University of Pisa, Via Paradisa, 2, 56021, Pisa, Italy
| | - Dario Tartaglia
- General and Emergency Unit and Trauma Center, New Santa Chiara Hospital, University of Pisa, Via Paradisa, 2, 56021, Pisa, Italy.
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Patwardhan UM, Floan GM, Calvo RY, Acker SN, Choi PM, Prieto JM, Bansal V, Sise MJ, Thangarajah H, Fairbanks TJ, Lazar DA, Ignacio RC. A Comparative Study of Laparoscopic versus Open Management of Index Small Bowel Obstruction in Children. J Pediatr Surg 2024; 59:416-420. [PMID: 37978001 DOI: 10.1016/j.jpedsurg.2023.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION There is limited literature on the optimal approach to treat adhesive small bowel obstruction (ASBO) in children. We sought to compare rates and outcomes of laparoscopic (LAP) and open (OPEN) surgery for pediatric ASBO. METHODS A California statewide database was used to identify children (<18 years old) with an index ASBO from 2007 to 2020. The primary outcome was the type of operative management: LAP or OPEN. Secondary outcomes were hospital characteristics, patient demographics, and postoperative complications. We excluded patients treated non-operatively. RESULTS Our study group had 545 patients. 381 (70%) underwent OPEN and 164 (30%) LAP during the index admission. Over the study period, there was increasing use of laparoscopic surgery, with higher use in older children (p < 0.001). LAP was associated with fewer overall complications (65.2% vs. 81.6%, p < 0.001), with a decreasing trend in complications over time (p < 0.001). The LAP group had significantly lower rates of bowel resection (4.9% vs. 17.1%, p < 0.001), length of stay (LOS) (17 vs. 23 days, p < 0.001), and TPN use (12.2% vs. 29.1%, p < 0.001). Mortality rates were equivalent. Although the LAP group had lower readmission rates (22.6% vs. 37.3%, p < 0.001), the length of time between discharge and readmission was similar (171 vs. 165 days, p = 0.190). DISCUSSION The use of laparoscopic surgery for index ASBO increased over the study period. However, it was less commonly utilized in younger children. LAP had fewer overall complications as well as shorter LOS, decreased TPN use, and fewer readmissions. The benefits and risks of each approach must be weighed. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Utsav M Patwardhan
- Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134, USA
| | - Gretchen M Floan
- Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134, USA
| | - Richard Y Calvo
- Scripps Mercy Hospital San Diego, 4077 Fifth Ave, San Diego, CA 92103, USA
| | - Shannon N Acker
- Colorado Children's Hospital, 13123 E 16th Ave, Aurora, CO 80045, USA
| | - Pamela M Choi
- Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134, USA
| | - James M Prieto
- Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134, USA
| | - Vishal Bansal
- Scripps Mercy Hospital San Diego, 4077 Fifth Ave, San Diego, CA 92103, USA
| | - Michael J Sise
- Scripps Mercy Hospital San Diego, 4077 Fifth Ave, San Diego, CA 92103, USA
| | - Hari Thangarajah
- Rady Children's Hospital San Diego, 3020 Children's Way, San Diego, CA 92123, USA; University of California San Diego School of Medicine, Department of Surgery, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - Timothy J Fairbanks
- Rady Children's Hospital San Diego, 3020 Children's Way, San Diego, CA 92123, USA; University of California San Diego School of Medicine, Department of Surgery, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - David A Lazar
- Rady Children's Hospital San Diego, 3020 Children's Way, San Diego, CA 92123, USA; University of California San Diego School of Medicine, Department of Surgery, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - Romeo C Ignacio
- Rady Children's Hospital San Diego, 3020 Children's Way, San Diego, CA 92123, USA; University of California San Diego School of Medicine, Department of Surgery, 9500 Gilman Dr, La Jolla, CA 92093, USA.
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6
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Sermonesi G, Tian BWCA, Vallicelli C, Abu-Zidan FM, Damaskos D, Kelly MD, Leppäniemi A, Galante JM, Tan E, Kirkpatrick AW, Khokha V, Romeo OM, Chirica M, Pikoulis M, Litvin A, Shelat VG, Sakakushev B, Wani I, Sall I, Fugazzola P, Cicuttin E, Toro A, Amico F, Mas FD, De Simone B, Sugrue M, Bonavina L, Campanelli G, Carcoforo P, Cobianchi L, Coccolini F, Chiarugi M, Di Carlo I, Di Saverio S, Podda M, Pisano M, Sartelli M, Testini M, Fette A, Rizoli S, Picetti E, Weber D, Latifi R, Kluger Y, Balogh ZJ, Biffl W, Jeekel H, Civil I, Hecker A, Ansaloni L, Bravi F, Agnoletti V, Beka SG, Moore EE, Catena F. Cesena guidelines: WSES consensus statement on laparoscopic-first approach to general surgery emergencies and abdominal trauma. World J Emerg Surg 2023; 18:57. [PMID: 38066631 PMCID: PMC10704840 DOI: 10.1186/s13017-023-00520-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/01/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Laparoscopy is widely adopted across nearly all surgical subspecialties in the elective setting. Initially finding indication in minor abdominal emergencies, it has gradually become the standard approach in the majority of elective general surgery procedures. Despite many technological advances and increasing acceptance, the laparoscopic approach remains underutilized in emergency general surgery and in abdominal trauma. Emergency laparotomy continues to carry a high morbidity and mortality. In recent years, there has been a growing interest from emergency and trauma surgeons in adopting minimally invasive surgery approaches in the acute surgical setting. The present position paper, supported by the World Society of Emergency Surgery (WSES), aims to provide a review of the literature to reach a consensus on the indications and benefits of a laparoscopic-first approach in patients requiring emergency abdominal surgery for general surgery emergencies or abdominal trauma. METHODS This position paper was developed according to the WSES methodology. A steering committee performed the literature review and drafted the position paper. An international panel of 54 experts then critically revised the manuscript and discussed it in detail, to develop a consensus on a position statement. RESULTS A total of 323 studies (systematic review and meta-analysis, randomized clinical trial, retrospective comparative cohort studies, case series) have been selected from an initial pool of 7409 studies. Evidence demonstrates several benefits of the laparoscopic approach in stable patients undergoing emergency abdominal surgery for general surgical emergencies or abdominal trauma. The selection of a stable patient seems to be of paramount importance for a safe adoption of a laparoscopic approach. In hemodynamically stable patients, the laparoscopic approach was found to be safe, feasible and effective as a therapeutic tool or helpful to identify further management steps and needs, resulting in improved outcomes, regardless of conversion. Appropriate patient selection, surgeon experience and rigorous minimally invasive surgical training, remain crucial factors to increase the adoption of laparoscopy in emergency general surgery and abdominal trauma. CONCLUSIONS The WSES expert panel suggests laparoscopy as the first approach for stable patients undergoing emergency abdominal surgery for general surgery emergencies and abdominal trauma.
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Affiliation(s)
- Giacomo Sermonesi
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | - Brian W C A Tian
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Carlo Vallicelli
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al‑Ain, United Arab Emirates
| | | | | | - Ari Leppäniemi
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Joseph M Galante
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Edward Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andrew W Kirkpatrick
- Departments of Surgery and Critical Care Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada
| | - Vladimir Khokha
- Department of Emergency Surgery, City Hospital, Mozyr, Belarus
| | - Oreste Marco Romeo
- Trauma, Burn, and Surgical Care Program, Bronson Methodist Hospital, Kalamazoo, MI, USA
| | - Mircea Chirica
- Department of Digestive Surgery, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
| | - Manos Pikoulis
- 3Rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Andrey Litvin
- Department of Surgical Diseases No. 3, Gomel State Medical University, Gomel, Belarus
| | | | - Boris Sakakushev
- General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - Imtiaz Wani
- Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Ibrahima Sall
- General Surgery Department, Military Teaching Hospital, Dakar, Senegal
| | - Paola Fugazzola
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Enrico Cicuttin
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Adriana Toro
- Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Francesco Amico
- Discipline of Surgery, School of Medicine and Public Health, Newcastle, Australia
| | - Francesca Dal Mas
- Department of Management, Ca' Foscari University of Venice, Campus Economico San Giobbe Cannaregio, 873, 30100, Venice, Italy
| | - Belinda De Simone
- Department of Emergency Surgery, Centre Hospitalier Intercommunal de Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
| | - Michael Sugrue
- Donegal Clinical Research Academy Emergency Surgery Outcome Project, Letterkenny University Hospital, Donegal, Ireland
| | - Luigi Bonavina
- Department of Surgery, IRCCS Policlinico San Donato, University of Milano, Milan, Italy
| | | | - Paolo Carcoforo
- Department of Surgery, S. Anna University Hospital and University of Ferrara, Ferrara, Italy
| | - Lorenzo Cobianchi
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Federico Coccolini
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Massimo Chiarugi
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Salomone Di Saverio
- General Surgery Department Hospital of San Benedetto del Tronto, Marche Region, Italy
| | - Mauro Podda
- Department of Surgical Science, Emergency Surgery Unit, University of Cagliari, Cagliari, Italy
| | - Michele Pisano
- General and Emergency Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Mario Testini
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery, University of Bari "A. Moro", Bari, Italy
| | - Andreas Fette
- Pediatric Surgery, Children's Care Center, SRH Klinikum Suhl, Suhl, Thuringia, Germany
| | - Sandro Rizoli
- Surgery Department, Section of Trauma Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero‑Universitaria Parma, Parma, Italy
| | - Dieter Weber
- Department of Trauma Surgery, Royal Perth Hospital, Perth, Australia
| | - Rifat Latifi
- Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Yoram Kluger
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Zsolt Janos Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
| | - Walter Biffl
- Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Hans Jeekel
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Ian Civil
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Andreas Hecker
- Emergency Medicine Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | - Luca Ansaloni
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Francesca Bravi
- Healthcare Administration, Santa Maria Delle Croci Hospital, Ravenna, Italy
| | - Vanni Agnoletti
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | | | - Ernest Eugene Moore
- Ernest E Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA
| | - Fausto Catena
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
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7
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Elkomos BE, Fahmy K, Kamel KA. Laparoscopic adhesiolysis versus open adhesiolysis in acute adhesive small bowel obstruction. J Minim Access Surg 2023; 19:511-517. [PMID: 37357493 PMCID: PMC10695316 DOI: 10.4103/jmas.jmas_43_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/11/2023] [Accepted: 04/07/2023] [Indexed: 06/27/2023] Open
Abstract
Introduction Exploratory laparotomy is still the standard therapy for patients who need surgical intervention for adhesive small bowel obstruction (SBO). However, the use of laparoscopy in the management of adhesive SBO is still controversial. We aimed to detect the short-term outcomes between open and laparoscopic adhesiolysis for SBO. Patients and Methods This is a retrospective study of patients with adhesive SBO who underwent either laparoscopic or open surgery from June 2019 to July 2022 at Ain Shams University Hospitals. Intraoperative and early post-operative outcomes were compared in the two groups. Results A total of 89 patients with adhesive SBO were included in our study. Fifty-one cases underwent open adhesiolysis and 38 cases underwent laparoscopic adhesiolysis. Laparoscopic adhesiolysis is associated with a remarkable decrease in the operative time (71 min vs. 107 min, P = 0.001) and blood loss (50 ml vs. 120 ml, P = 0.001) in comparison to open adhesiolysis. In addition to that, those who underwent adhesiolysis by laparoscopy had a short hospital stay (2.4 days vs. 3.8 days, P = 0.001), early recovery (time to pass flatus 1.3 days vs. 2.8 days) and less post-operative complications (surgical site infection [SSI] 2.6% vs. 19.6%, P = 0.001). Moreover, open adhesiolysis is associated with a higher rate of early post-operative mortality. In addition to that, the incidence of iatrogenic injury was higher in the open group. Conclusion Laparoscopic adhesiolysis is a safe and feasible approach for the management of SBO and has better short-term outcomes, especially if done by skilled surgeons in advanced laparoscopic techniques.
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Affiliation(s)
| | - Karim Fahmy
- Department of General Surgery, Ain Shams University Hospital, Cairo, Egypt
| | - Kareem Ahmed Kamel
- Department of General Surgery, Ain Shams University Hospital, Cairo, Egypt
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8
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Sebastian-Valverde E, Téllez C, Burdío F, Poves I, Grande L. Individualization of the best approach for adhesive small bowel obstruction. ANZ J Surg 2023; 93:2132-2137. [PMID: 37530170 DOI: 10.1111/ans.18649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/24/2023] [Accepted: 07/24/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Laparoscopic postoperatives outcomes in adhesiolysis are promising but conversion and morbidity remains high. The objective of our study was to determine preoperative factors to individualize and select the most appropriate approach for each patient. METHODS Patients ≥18 years old undergoing emergent surgery for adhesive small bowel obstruction and internal hernias were evaluated. Bivariate and multivariate analysis were performed to investigate factors related to conversion to open surgery and to the type of adhesions. RESULTS Of 333 patients, 224 were operated by laparotomy and 109 by laparoscopy (conversion rate: 40%). Previous abdominal wall mesh, type of adhesions, bowel lesion, need for intestinal resection and laparoscopic skills were statistically related to conversion. In the multivariate analysis, complex adhesions (OR 4.3, 95% CI 1.5-12.2; P = 0.006), the need for intestinal resection (OR 14.16, 95% CI 2.55-78.68; P = 0.002), and non-advanced laparoscopy surgeons (OR 4.31, 95% CI 1.56-11.94; P = 0.005) were independent factors for conversion to open surgery. ASA III-IV, previous surgeries, previous abdominal mesh and previous adhesiolysis were related to complex adhesions. Previous laparoscopic surgery and internal hernia or closed loop in computed tomography were associated with simple adhesions as a cause of the obstruction. In the multivariate, previous adhesiolysis (OR 4.76, 95% CI 1.23-18.3; P = 0.023) and the findings on computed tomography were significantly related with the type of adhesion. CONCLUSION Some preoperative factors allow to individualize the surgical approach in the adhesive small bowel obstruction improving surgical outcomes.
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Affiliation(s)
- Enric Sebastian-Valverde
- Department of Surgery, Hospital de Sant Boi, Sant Boi de Llobregat, Spain
- Department of Surgery, Hospital Universitari del Mar, Barcelona, Spain
| | - Clara Téllez
- Department of Surgery, Hospital Universitari del Mar, Barcelona, Spain
| | - Fernando Burdío
- Department of Surgery, Hospital Universitari del Mar, Barcelona, Spain
- Health and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Ignasi Poves
- Department of Surgery, Hospital Universitari del Mar, Barcelona, Spain
| | - Luis Grande
- Department of Surgery, Hospital Universitari del Mar, Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
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9
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Wassmer CH, Revol R, Uhe I, Chevallay M, Toso C, Gervaz P, Morel P, Poletti PA, Platon A, Ris F, Schwenter F, Perneger T, Meier RP. A new clinical severity score for the management of acute small bowel obstruction in predicting bowel ischemia: a cohort study. Int J Surg 2023; 109:1620-1628. [PMID: 37026805 PMCID: PMC10389338 DOI: 10.1097/js9.0000000000000171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 12/28/2022] [Indexed: 04/08/2023]
Abstract
BACKGROUND Small bowel obstruction (SBO) is a common hospital admission diagnosis. Identification of patients who will require a surgical resection because of a nonviable small bowel remains a challenge. Through a prospective cohort study, the authors aimed to validate risk factors and scores for intestinal resection, and to develop a practical clinical score designed to guide surgical versus conservative management. PATIENTS AND METHODS All patients admitted for an acute SBO between 2004 and 2016 in the center were included. Patients were divided in three categories depending on the management: conservative, surgical with bowel resection, and surgical without bowel resection. The outcome variable was small bowel necrosis. Logistic regression models were used to identify the best predictors. RESULTS Seven hundred and thirteen patients were included in this study, 492 in the development cohort and 221 in the validation cohort. Sixty-seven percent had surgery, of which 21% had small bowel resection. Thirty-three percent were treated conservatively. Eight variables were identified with a strong association with small bowel resection: age 70 years of age and above, first episode of SBO, no bowel movement for greater than or equal to 3 days, abdominal guarding, C-reactive protein greater than or equal to 50, and three abdominal computer tomography scanner signs: small bowel transition point, lack of small bowel contrast enhancement, and the presence of greater than 500 ml of intra-abdominal fluid. Sensitivity and specificity of this score were 65 and 88%, respectively, and the area under the curve was 0.84 (95% CI: 0.80-0.89). CONCLUSION The authors developed and validated a practical clinical severity score designed to tailor management of patients presenting with an SBO.
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Affiliation(s)
| | - Rebecca Revol
- Department of Surgery, University Hospitals of Geneva and Medical School
| | - Isabelle Uhe
- Department of Surgery, University Hospitals of Geneva and Medical School
| | - Mickaël Chevallay
- Department of Surgery, University Hospitals of Geneva and Medical School
| | - Christian Toso
- Department of Surgery, University Hospitals of Geneva and Medical School
| | - Pascal Gervaz
- Department of Surgery, University Hospitals of Geneva and Medical School
| | - Philippe Morel
- Department of Surgery, University Hospitals of Geneva and Medical School
| | | | | | - Frederic Ris
- Department of Surgery, University Hospitals of Geneva and Medical School
| | - Frank Schwenter
- Department of Surgery, Montreal University Hospital CHUM, Université de Montréal, Montréal, Quebec, Canada
| | - Thomas Perneger
- Division of Clinical Epidemiology, Faculty of Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
| | - Raphael P.H. Meier
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
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10
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Liu W, Wu F, Bi X, Hou L, Wang C, Li Y, Zeng Z, Xia C, Tang L, Hou C. Herbal formula Jiawei Xiaochengqi decoction prevents postoperative abdominal adhesion in a rat model through inhibition of CXCL2-CXCR2 pathway. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2023; 111:154662. [PMID: 36681054 DOI: 10.1016/j.phymed.2023.154662] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/04/2023] [Accepted: 01/09/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Postoperative abdominal adhesion (PAA) is the most common complication after abdominal surgeries, which can lead to intestinal obstruction, chronic abdominal pain or female infertility. Jiawei Xiaochengqi decoction (JWXCQ) is a hospital preparation widely used for PAA treatment in Nanfang Hospital of Southern Medical University for more than twenty years. PURPOSE This study aimed to investigate the therapeutic effects and potential mechanism of JWXCQ against PAA and provide beneficial information for its clinical application. METHODS The main active components of JWXCQ were identified using ultra high performance liquid chromatography (UHPLC) combined with standard substance comparison. The efficacy and underlying mechanism of JWXCQ were evaluated through in vivo experiments with a postsurgical-induced peritoneal adhesion rat model, and in vitro studies with LPS-stimulated Raw 264.7 macrophages and primary fibroblasts. H&E and Masson staining were performed to assess histopathological changes. The levels of cytokines/proteins-associated with inflammation and degradation of extracellular matrix as well as CXCL2-CXCR2 pathway-related proteins were determined by ELISA, qRT-PCR, western blot assays or immunohistochemistry, respectively. Furthermore, siCXCR2 transfection was used to validate the mechanism of action of JWXCQ. RESULTS JWXCQ treatment significantly reduced the formation of PAA, inhibited the inflammation and collagen deposition, and facilitated the secretion of MMP9, decreased the levels of IL-1β, IL-6, TIMP1, COL-1, and suppressed the CXCL2-CXCR2 pathway in PAA rats. Furthermore, JWXCQ inhibited its downstream pathways, the JAK2-STAT3 and PI3K-AKT signaling, as indicated by the suppression of the phosphorylation levels of STAT3 and AKT. In vitro cell experiments revealed that JWXCQ reduced IL-1β and IL-6 secretion in Raw 264.7 macrophages and COL-1 in primary fibroblasts. The CXCL2-CXCR2, JAK2-STAT3 and PI3K-AKT pathways were also inhibited after JWXCQ treatment, which were consistent with the in vivo results. More importantly, silence of CXCR2 eliminated the regulatory effects of JWXCQ. CONCLUSION JWXCQ could effectively prevent the PAA formation by alleviating inflammation and collagen deposition, which was associated with the inhibition of CXCL2-CXCR2 pathway. This study investigated the relevant pharmacological mechanisms of JWXCQ, providing further evidence for the application of JWXCQ in clinical PAA treatment.
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Affiliation(s)
- Wenqin Liu
- Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University (Foshan Maternity & Child Healthcare Hospital), Foshan 528000, China; School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Fuling Wu
- Clinical Pharmacy Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Xiaoli Bi
- Analysis Department of Chinese Medicine, Guangdong Province Engineering Technology Research Institute of Traditional Chinese Medicine, Guangzhou 510515, China
| | - Lianbing Hou
- Clinical Pharmacy Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China; NMPA Key Laboratory for Research and Evaluation of Drug Metabolism, Guangdong Provincial Key Laboratory of New Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Chunxia Wang
- Clinical Pharmacy Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Yangxue Li
- Analysis Department of Chinese Medicine, Guangdong Province Engineering Technology Research Institute of Traditional Chinese Medicine, Guangzhou 510515, China
| | - Zhihao Zeng
- Analysis Department of Chinese Medicine, Guangdong Province Engineering Technology Research Institute of Traditional Chinese Medicine, Guangzhou 510515, China
| | - Chenglai Xia
- Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University (Foshan Maternity & Child Healthcare Hospital), Foshan 528000, China; School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China.
| | - Lan Tang
- NMPA Key Laboratory for Research and Evaluation of Drug Metabolism, Guangdong Provincial Key Laboratory of New Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China.
| | - Chuqi Hou
- Clinical Pharmacy Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China; NMPA Key Laboratory for Research and Evaluation of Drug Metabolism, Guangdong Provincial Key Laboratory of New Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China.
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11
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van den Beukel BAW, Toneman MK, van Veelen F, van Oud-Alblas MB, van Dongen K, Stommel MWJ, van Goor H, ten Broek RPG. Elective adhesiolysis for chronic abdominal pain reduces long-term risk of adhesive small bowel obstruction. World J Emerg Surg 2023; 18:8. [PMID: 36691000 PMCID: PMC9872389 DOI: 10.1186/s13017-023-00477-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 01/10/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Selected patients with adhesion-related chronic abdominal pain can be treated effectively by adhesiolysis with the application of adhesion barriers. These patients might also have an increased risk to develop adhesive small bowel obstruction (ASBO). It is unknown how frequently these patients develop ASBO, and how elective adhesiolysis for pain impacts the risk of ASBO. METHODS Patients with adhesion-related chronic pain were included in this cohort study with long-term follow-up. The diagnosis of adhesions was confirmed using CineMRI. The decision for operative treatment of adhesions was made by shared agreement based on the correlation of complaints with CineMRI findings. The primary outcome was the 5-years incidence of readmission for ASBO. Incidence was compared between patients with elective adhesiolysis and those treated non-operatively and between patients with and without previous ASBO. Univariable and multivariable Cox regression analysis was performed to identify predictive factors for ASBO. Secondary outcomes included reoperation for ASBO and self-reported pain and other abdominal symptoms. RESULTS A total of 122 patients were included, 69 patients underwent elective adhesiolysis. Thirty patients in both groups had previous episodes of ASBO in history. During 5-year follow-up, the readmission rate for ASBO was 6.5% after elective adhesiolysis compared to 26.9% after non-operative treatment (p = 0.012). These percentages were 13.3% compared to 40% in the subgroup of patients with previous episodes of ASBO (p = 0.039). In multivariable analysis, elective adhesiolysis was associated with a decreased risk of readmission for ASBO with an odds ratio of 0.21 (95% CI 0.07-0.65), the risk was increased in patients with previous episodes with a odds ratio of 19.2 (95% CI 2.5-144.4). There was no difference between the groups in the prevalence of self-reported abdominal pain. However, in surgically treated patients the impact of pain on daily activities was lower, and the incidence of other symptoms was lower. CONCLUSION More than one in four patients with chronic adhesion-related pain develop episodes of ASBO when treated non-operatively. Elective adhesiolysis reduces the incidence of ASBO in patients with chronic adhesion-related symptoms, both in patients with and without previous episodes of ASBO in history. Trial registration The study was registered at Clinicaltrials.gov under NCT01236625.
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Affiliation(s)
- Barend A. W. van den Beukel
- grid.10417.330000 0004 0444 9382Department of Surgery, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Masja K. Toneman
- grid.10417.330000 0004 0444 9382Department of Surgery, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Fleur van Veelen
- grid.10417.330000 0004 0444 9382Department of Surgery, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | | | - Koen van Dongen
- Department of Surgery, Pantein Hospital Boxmeer, Beugen, The Netherlands
| | - Martijn W. J. Stommel
- grid.10417.330000 0004 0444 9382Department of Surgery, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Harry van Goor
- grid.10417.330000 0004 0444 9382Department of Surgery, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Richard P. G. ten Broek
- grid.10417.330000 0004 0444 9382Department of Surgery, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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12
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Green L, Stienstra R, Brown LR, McLean RC, Wilson MSJ, Crumley ABC, Hendry PO. Evaluating temporal trends and the impact of surgical subspecialisation on patient outcomes following adhesional small bowel obstruction: a multicentre cohort study. Eur J Trauma Emerg Surg 2023; 49:1343-1353. [PMID: 36653530 DOI: 10.1007/s00068-023-02224-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/07/2023] [Indexed: 01/20/2023]
Abstract
PURPOSE Small bowel obstruction (SBO) is the most common indication for laparotomy in the UK. While general surgeons have become increasingly subspecialised in their elective practice, emergency admissions commonly remain undifferentiated. This study aimed to assess temporal trends in the management of adhesional SBO and explore the influence of subspecialisation on patient outcomes. METHODS Data was collected for patients admitted acutely with adhesional SBO across acute NHS trusts in Northern England between 01/01/02 and 31/12/16, including demographics, co-morbidities and procedures performed. Patients were excluded if a potentially non-adhesional cause was identified and were grouped by the responsible consultant's subspecialty. The primary outcome of interest was 30-day inpatient mortality. RESULTS Overall, 2818 patients were admitted with adhesional SBO during a 15-year period. There was a consistent female preponderance, but age and comorbidity increased significantly over time (both p < 0.001). In recent years, more patients were managed operatively with a trend away from delayed surgery also evident (2002-2006: 65.7% vs. 2012-2016: 42.7%, p < 0.001). Delayed surgery was associated with an increased mortality risk on multivariable regression analysis (OR: 2.46 (1.46-4.23, p = 0.001)). CT scanning was not associated with management strategy or timing of surgery (p = 0.369). There was an increased propensity for patients to be managed by gastrointestinal (colorectal and upper gastrointestinal) subspecialists over time. Length of stay (p < 0.001) and 30-day mortality (p < 0.001) both improved in recent years, with the best outcomes seen in colorectal (2.6%) and vascular subspecialists (2.4%). However, following adjustment for confounding variables, consultant subspecialty was not a predictor of mortality. CONCLUSION Outcomes for patients presenting with adhesional SBO have improved despite the increasing burden of age and co-morbidity. While gastrointestinal subspecialists are increasingly responsible for their care, mortality is not influenced by consultant subspecialty.
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Affiliation(s)
- Lewis Green
- Department of General Surgery, Forth Valley Royal Hospital, Larbert, Scotland
| | - Roxane Stienstra
- Department of General Surgery, Forth Valley Royal Hospital, Larbert, Scotland
| | - Leo R Brown
- Department of General Surgery, Forth Valley Royal Hospital, Larbert, Scotland. .,Clinical Surgery, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, Scotland.
| | - Ross C McLean
- Department of General Surgery, Queen Elizabeth Hospital, Gateshead, England
| | - Michael S J Wilson
- Department of General Surgery, Forth Valley Royal Hospital, Larbert, Scotland
| | - Andrew B C Crumley
- Department of General Surgery, Forth Valley Royal Hospital, Larbert, Scotland
| | - Paul O Hendry
- Department of General Surgery, Forth Valley Royal Hospital, Larbert, Scotland
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13
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da Costa RID, Fischer JMDS, Rasslan R, Koike MK, Utiyama EM, Montero EFDS. Effects of N-acetylcysteine on the inflammatory response and bacterial translocation in a model of intestinal obstruction and ischemia in rats. Acta Cir Bras 2023; 37:e371204. [PMID: 36651429 PMCID: PMC9839184 DOI: 10.1590/acb371204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 11/25/2022] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To evaluate effect of N-acetylcysteine (NAC) associated with Ringer lactate or hypertonic saline in inflammation and bacterial translocation on experimental intestinal obstruction (IO). METHODS Wistar rats was subjected to IO. Six or 24 hours after, rats were subjected to enterectomy and fluid resuscitation: IO, RL (subjected to the same procedures but with fluid resuscitation using Ringer's lactate solution); RLNAC (added NAC to Ringer's solution); and HSNAC (surgical procedure + fluid reposition with 7.5% hypertonic saline and NAC). After 24 h, tissues were collected to cytokines, bacterial translocation, and histological assessments. RESULTS In kidney, interleukin-1beta (IL-1beta) was lower in the groups with fluid resuscitation compared to IO group. The RLNAC showed lower levels compared to the RL. Interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-alpha), and (IFN-gamma) were lower in the treatment groups than in IO. In lung, IL-1beta and IL-6 were lower in RLNAC compared to IO. IL-10 was lower in RL, RLNAC and HSNAC compared to IO. TNF-alpha was higher in HSNAC compared to both RL and RLNAC. Bacterial translocation was observed in all animals of IO group. In kidneys, inflammation and congestion degrees were lower in HSNAC compared to RL. In lungs, inflammation levels were higher in RLNAC compared with the sham group. CONCLUSIONS The data indicates that NAC associated with RL can promote a decrease in the inflammatory process in the kidneys and lungs in rats, following intestinal obstruction and ischemia in rats.
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Affiliation(s)
- Rafael Izar Domingues da Costa
- PhD. Universidade de São Paulo – Division of General Surgery and Trauma – Department of Surgery – School of Medicine – São Paulo (SP), and Universidade Federal de São Carlos – São Carlos (SP), Brazil.,Corresponding author:
- (55 16) 3415-3787
| | | | - Roberto Rasslan
- PhD. Universidade de São Paulo – Division of General Surgery and Trauma – Department of Surgery – School of Medicine – São Paulo (SP), Brazil
| | - Marcia Kiyomi Koike
- PhD. Universidade de São Paulo – Department of Clinical Medicine – Laboratory of Emergency Medicine – School of Medicine – São Paulo (SP), Brazil. And Instituto de Assistência Médica do Servidor Publico Estadual (IAMSPE) - Pós-Graduação em Ciencias da Saúde, São Paulo (SP), Brazil
| | - Edvaldo Massazo Utiyama
- PhD, full professor. Universidade de São Paulo – Division of General Surgery and Trauma – Department of Surgery – School of Medicine – São Paulo (SP), Brazil
| | - Edna Frasson de Souza Montero
- PhD, associate professor. Universidade de São Paulo – Division of General Surgery and Trauma – Department of Surgery – School of Medicine – São Paulo (SP), Brazil
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14
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Demessence R, Lyoubi Y, Feuerstoss F, Hamy A, Aubé C, Paisant A, Venara A. Surgical management of adhesive small bowel obstruction: Is it still mandatory to wait? - An update. J Visc Surg 2022; 159:309-319. [PMID: 35272958 DOI: 10.1016/j.jviscsurg.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Small bowel obstruction syndromes (SBO) represent one of the main causes of emergency admission for surgical abdominal pain. The 2018 Bologna Guidelines (Ten Broek et al. 2018) recommend non-operative management at the outset if there are no signs of severity; surgery is proposed after 72h for the 20-30% of patients who fail medical management. However, these recommendations were based on old studies published at a time when laparoscopic surgery was not commonplace and when diagnostic capabilities (particularly for establishing etiology) were less developed than they are today. Additionally, the advent and development of laparoscopy and enhanced rehabilitation after surgery have led to a decrease in surgical morbidity. These guidelines are therefore now debated and several recent publications have encouraged urgent or semi-urgent surgical management for patients presenting for SBO in order to reduce morbidity, mortality, duration of hospitalization and costs, and to improve the feasibility of therapeutic laparoscopy. Prompt surgical management could also reduce the risk of recurrent small bowel obstructions. This model for early surgical management probably cannot be applied to all patients. It therefore seems important to select those patients at risk for failure of medical treatment and to identify those in whom the probability of successful laparoscopy is high. New radiological tools should allow better selection in the future. At the present time, the indications for early surgery "within 24h" should be emphasized.
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Affiliation(s)
- R Demessence
- Visceral and endocrine surgery department, CHU d'Angers, 4, rue Larrey, 49933 Angers Cedex 9, France; Faculty of Health of Angers, Department of Medicine, Angers, France
| | - Y Lyoubi
- Faculty of Health of Angers, Department of Medicine, Angers, France; Urology Department, CHU d'Angers, 49933 Angers Cedex 9, France
| | - F Feuerstoss
- Faculty of Health of Angers, Department of Medicine, Angers, France; Department of Radiology, CHU d'Angers, 49933 Angers Cedex 9, France
| | - A Hamy
- Visceral and endocrine surgery department, CHU d'Angers, 4, rue Larrey, 49933 Angers Cedex 9, France; Faculty of Health of Angers, Department of Medicine, Angers, France
| | - C Aubé
- Faculty of Health of Angers, Department of Medicine, Angers, France; Department of Radiology, CHU d'Angers, 49933 Angers Cedex 9, France; HIFIH, UPRES EA 3858, University of Angers, Angers, France
| | - A Paisant
- Faculty of Health of Angers, Department of Medicine, Angers, France; Department of Radiology, CHU d'Angers, 49933 Angers Cedex 9, France; HIFIH, UPRES EA 3858, University of Angers, Angers, France
| | - A Venara
- Visceral and endocrine surgery department, CHU d'Angers, 4, rue Larrey, 49933 Angers Cedex 9, France; Faculty of Health of Angers, Department of Medicine, Angers, France; HIFIH, UPRES EA 3858, University of Angers, Angers, France.
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15
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Tepelenis K, Stefanou SK, Stefanou CK, Tepelenis N, Margariti P, Christopoulou A, Gogos-Pappas G, Vlachos K. Small bowel obstruction due to a congenital adhesion: a rare case report. J Surg Case Rep 2021; 2021:rjab282. [PMID: 34234943 PMCID: PMC8257260 DOI: 10.1093/jscr/rjab282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 06/10/2021] [Indexed: 01/18/2023] Open
Abstract
The exact incidence of small bowel obstruction (SBO) due to congenital adhesions remains unclear. Herein, we report a 59-year-old male who appeared in the emergency department with diffuse abdominal pain associated with vomiting. The patient reported no previous medical or surgical history. Clinical examination revealed a soft, distended abdomen and diffuse tenderness. Computed tomography indicated a close loop obstruction. A congenital band extending from mesentery to ileum and causing an internal hernia was identified via a midline incision. The band was ligated and divided. There is no difference in the clinical presentation, and the initial work-up of SBO on account of congenital adhesions was compared to other bowel obstruction causes. Surgical exploration is crucial for the diagnosis and treatment of congenital adhesions. Although laparotomy is considered the cornerstone of surgical management, laparoscopy has emerged as a feasible and safe alternative for the diagnosis and treatment of these congenital bands.
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Affiliation(s)
- Kostas Tepelenis
- Department of Surgery, University Hospital of Ioannina, Ioannina, Greece
| | - Stefanos K Stefanou
- Department of Surgery, General Hospital of Ioannina G. Xatzikosta, Ioannina, Greece
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16
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Racine M, Kohler R, Chautems R. Incarcerated Small-Bowel Pericardial Diaphragmatic Hernia After Pericardio-Peritoneal Window Creation: Report of a Rare Case. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e930441. [PMID: 33850094 PMCID: PMC8056778 DOI: 10.12659/ajcr.930441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Female, 84-year-old Final Diagnosis: Diaphragmatic hernia • small bowel obstruction Symptoms: Abdominal pain Medication: — Clinical Procedure: Laparoscopic surgery Specialty: Surgery
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Affiliation(s)
- Michaël Racine
- Department of Surgery, Neuchâtel Hospital Network (RHNe) - Pourtalès, Neuchâtel, Switzerland
| | - Rémy Kohler
- Department of Surgery, Neuchâtel Hospital Network (RHNe) - Pourtalès, Neuchâtel, Switzerland
| | - Roland Chautems
- Department of Surgery, Neuchâtel Hospital Network (RHNe) - Pourtalès, Neuchâtel, Switzerland
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17
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Berge P, Delestre M, Paisant A, Hamy A, Aubé C, Hamel JF, Venara A. Diagnosis of single adhesive bands versus matted adhesions in small bowel obstructions: a radiological predictive score. Eur J Trauma Emerg Surg 2021; 48:13-22. [PMID: 33420593 DOI: 10.1007/s00068-020-01580-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 12/16/2020] [Indexed: 01/11/2023]
Abstract
PURPOSE The objective was to develop a radiological score obtained from multi-detector computed tomography (MDCT) to differentiate between single band adhesion (SBA) and matted adhesions (MA) as the etiology of small bowel obstruction (SBO). METHODS All consecutive patients who underwent surgery from January 2013 to June 2018 for adhesion-induced SBO were retrospectively included. RESULTS Among the 193 patients having surgery for SBO, 119 (61.6%) had SBA and 74 (38.4%) had MA surgically proven. In multivariate analysis, the presence of a beak sign (OR = 3.47, CI [1.26; 9.53], p = 0.02), a closed loop (OR = 11.37, CI [1.84; 70.39], p = 0.009), focal mesenteric haziness (OR = 3.71, CI [1.33; 10.34], p = 0.01) and focal and diffuse peritoneal fluid (OR = 4.30, CI [1.45; 12.73], p = 0.009 and OR = 6.34, CI [1.77; 22.59], p = 0.004, respectively) were significantly associated with SBA. Conversely, the presence of diffuse mesenteric fluid without focal fluid (OR = 0.23, CI [0.06; 0.92], p = 0.04) and an increase of the diameter of the most dilated loop (OR = 0.94, CI [0.90; 0.99], p = 0.02) were inversely associated with SBA. Using the significant predictive factors of SBA, we built a composite score to radiologically predict the etiology of SBO. The area under the receiver operating characteristic (ROC) curve of the score was 0.8274. For a cut-off score of -0.523, sensitivity, specificity and the percentage of patients correctly classified were 78.4%, 84.6% and 80%, respectively. If the score is ≥ 7, the probability that the mechanism of SBO is not SBA was 100%. CONCLUSIONS The present score, validated in a different population, could be a significant tool in the decision for surgical management.
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Affiliation(s)
- Pierre Berge
- Department of Radiology, University Hospital of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France
- Department of Medicine, University of Health- Angers, Angers, France
| | - Maxime Delestre
- Department of Medicine, University of Health- Angers, Angers, France
- Department of Digestive and Endocrine Surgery, University Hospital of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France
| | - Anita Paisant
- Department of Radiology, University Hospital of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France
- Department of Medicine, University of Health- Angers, Angers, France
- HIFIH, UPRES, University of Angers, 3859, Angers, EA, France
| | - Antoine Hamy
- Department of Medicine, University of Health- Angers, Angers, France
- Department of Digestive and Endocrine Surgery, University Hospital of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France
- HIFIH, UPRES, University of Angers, 3859, Angers, EA, France
| | - Christophe Aubé
- Department of Radiology, University Hospital of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France
- Department of Medicine, University of Health- Angers, Angers, France
- HIFIH, UPRES, University of Angers, 3859, Angers, EA, France
| | - Jean-François Hamel
- Department of Medicine, University of Health- Angers, Angers, France
- Department of Biostatistics, Maison de la Recherche, University Hospital of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France
| | - Aurélien Venara
- Department of Medicine, University of Health- Angers, Angers, France.
- Department of Digestive and Endocrine Surgery, University Hospital of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France.
- HIFIH, UPRES, University of Angers, 3859, Angers, EA, France.
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