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Small Bowel Obstruction

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Multi-institutional, prospective, observational study comparing the Gastrografin challenge versus standard treatment in adhesive small bowel obstruction.
Zielinski MD, Haddad NN, Cullinane DC, Inaba K, Yeh DD, Wydo S, Turay D, Pakula A, Duane TM, Watras J, Widom KA, Cull J, Rodriguez CJ, Toschlog EA, Sams VG, Hazelton JP, Graybill JC, Skinner R, Yune JM; EAST SBO Workgroup: Martin D. Zielinski, MD; Nadeem N. Haddad, MD; Asad J. Choudhry, MBBS; Daniel C. Cullinane, MD; Kenji Inaba, MD; Agustin Escalante; D. Dante Yeh, MD; Salina Wydo, MD; David Turay, MD; Andrea Pakula, MD; Therese M. Duane, MD; Jill Watras, MD; Kenneth A. Widom, MD; John Cull, MD; Carlos J. Rodriguez, DO; Eric A. Toschlog, MD; Valerie G. Sams, MD; Joshua P. Hazelton, DO; John Christopher Graybill, MD, Ruby Skinner, MD, Ji-Ming Yune, MD.
J Trauma Acute Care Surg. 2017 Jul;83(1):47-54.

Rationale for inclusion: EAST sponsored multi-institutional, prospective, observational study performed on patients appropriate for Gastrografin with adhesive SBO. Patients receiving Gastrografin for adhesive SBO had lower rates of exploration and shorter hospital length of stay compared to patients who did not receive Gastrografin.

Citations - 0 (as of January 2018)

Patients With Adhesive Small Bowel Obstruction Should Be Primarily Managed by a Surgical Team
Aquina CT, Becerra AZ, Probst CP, Xu Z, Hensley BJ, Iannuzzi JC, Noyes K, Monson JR, Fleming FJ.
Ann Surg. 2016 Sep;264(3):437-47.

Rationale for inclusion: This large study confirms that patients with SBO managed by a surgical team have superior outcomes compared to those managed by a medical team.

Citations - 5 (as of July 2017)

Missed Opportunity: Laparoscopic Colorectal Resection Is Associated With Lower Incidence of Small Bowel Obstruction Compared to an Open Approach.
Aquina, C.; Probst, CP; Becerra, AZ; Iannuzzi, JC.; Hensley, BJ.; Noyes, K; Monson, JT.; Fleming, FJ.
Ann Surg. 2016 Jul;264(1):127-34.

Rationale for inclusion: This large study confirms that the incidence of SBO is lower after laparoscopic vs. open surgery.

Citations - 16 (as of July 2017)

How many sunsets? Timing of surgery in adhesive small bowel obstruction: a study of the nationwide inpatient sample.
Schraufnagel D, Rajaee S, Millham FH.
J Trauma Acute Care Surg. 2013 Jan;74(1):181-7; discussion 187-9.

Rationale for inclusion: With the advent of acute care surgery, we have an enhanced recognition that early treatment for a myriad of surgical pathologies improves outcomes. This paper, by virtue of using a secondary database, contains the largest sample of data available on this topic and reconfirms that delays in treatment represent poor management.

Citations - 49 (as of July 2017)

Evaluation and management of small-bowel obstruction: an Eastern Association for the Surgery of Trauma practice management guideline.
Maung AA, Johnson DC, Piper GL, Barbosa RR, Rowell SE, Bokhari F, Collins JN, Gordon JR, Ra JH, Kerwin AJ; Eastern Association for the Surgery of Trauma.
J Trauma Acute Care Surg. 2012 Nov;73(5 Suppl 4):S362-9.

Rationale for inclusion: This paper represents one of the initial Practice Management Guidelines and was developed by EAST. Using an inclusive approach to the literature search, the authors were able to answer several questions germane to SBO management based on the quality of the literature. The questions include routine use of CT, indications of strangulation obstructions which warrant early exploration, indications for laparoscopic explorations, and reasons for the use of Gastrografin.

Citations - 71 (as of July 2017)

Prospective, observational validation of a multivariate small-bowel obstruction model to predict the need for operative intervention.
Zielinski MD, Eiken PW, Heller SF, Lohse CM, Huebner M, Sarr MG, Bannon MP.
J Am Coll Surg. 2011 Jun;212(6):1068-76.

Rationale for inclusion: This paper provides validated an evidence based protocol for the management of SBO. The protocol incorporates clinical and radiographic features to predict strangulation obstructions as well as failure of non-operative management. The guideline was designed to be straightforward and easy to implement.

Citations - 41 (as of July 2017)

Systematic review and meta-analysis of the diagnostic and therapeutic role of water-soluble contrast agent in adhesive small bowel obstruction.
Branco BC, Barmparas G, Schnüriger B, Inaba K, Chan LS, Demetriades D.
Br J Surg. 2010 Apr;97(4):470-8.

Rationale for inclusion: There are 14 randomized, controlled trials in the use of Gastrografin for the management of SBO. This paper is a meta-analysis of all of them. It highlights the shortcomings of the trials, which are significant. Nevertheless, it provides further data on the beneficial effects of Gastrografin for diagnostic and therapeutic utilization in SBO.

Citations - 113 (as of July 2017)

Reduction in adhesive small-bowel obstruction by Seprafilm adhesion barrier after intestinal resection.
Fazio VW, Cohen Z, Fleshman JW, van Goor H, Bauer JJ, Wolff BG, Corman M, Beart RW Jr, Wexner SD, Becker JM, Monson JR, Kaufman HS, Beck DE, Bailey HR, Ludwig KA, Stamos MJ, Darzi A, Bleday R, Dorazio R, Madoff RD, Smith LE, Gearhart S, Lillemoe K, Göhl J.
Dis Colon Rectum. 2006 Jan;49(1):1-11.

Rationale for inclusion: Prospective, randomized trial which showed mild benefit with a commercial anti-adhesive product.

Citations - 331 (as of July 2017)

Long-term prognosis after operation for adhesive small bowel obstruction.
Fevang BT, Fevang J, Lie SA, Søreide O, Svanes K, Viste A.
Ann Surg. 2004 Aug;240(2):193-201.

Rationale for inclusion: Despite the retrospective nature, this study provides long-term outcomes and risk factors for SBO occurrence and recurrence. In particular, the duration of time from index to readmission is outlined both for patients who underwent operative and non-operative management. This is critical data when providing informed consent to patients who are wondering if an operative approach is appropriate based on long-term outcomes.

Citations - 201 (as of July 2017)

Laparoscopic treatment of acute small bowel obstruction: a multicentre retrospective study.
Levard H, Boudet MJ, Msika S, Molkhou JM, Hay JM, Laborde Y, Gillet M, Fingerhut A; French Association for Surgical Research.
ANZ J Surg. 2001 Nov;71(11):641-6.

Rationale for inclusion: As a multi-institutional study, this represents largest experience with the laparoscopic management of SBO contained within one paper. It provides data supporting the use of laparoscopy for SBO management as well as risk factors for conversion to open procedures.

Citations - 131 (as of July 2017)

Therapeutic effect of oral Gastrografin in adhesive, partial small-bowel obstruction: a prospective randomized trial.
Assalia A, Schein M, Kopelman D, Hirshberg A, Hashmonai M.
Surgery. 1994 Apr;115(4):433-7.

Rationale for inclusion: The first randomized, controlled trial in the use of the Gastrografin Challenge. This study demonstrated both a positive diagnostic and positive therapeutic effect for the use of Gastrografin. Most additional studies have confirmed these results.

Citations - 155 (as of July 2017)

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