Feasibility and safety of an algorithm for the management of adhesive small bowel obstruction.

IF 1.8 3区医学 Q2 SURGERY

Langenbeck's Archives of Surgery Pub Date : 2025-09-03 DOI:10.1007/s00423-025-03820-7

Dimitri Chappalley, Nicolas Dupasquier, Gabriel Heierli, Maria Teresa Torres, Dieter Hahnloser, Fabian Grass, Martin Hübner

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Abstract

Introduction: This single-center, prospective cohort study assessed the feasibility and safety of a structured management protocol (Ileus Management Algorithm Protocol: I-MAP) for patients with adhesive small bowel obstruction (ASBO).

Method: Among 63 patients initially admitted for ASBO, 40 met the inclusion criteria and were managed in line with I-MAP, incorporating nasogastric tube (NGT) output and water-soluble contrast (WSC) administration within a standardized decision-making framework.

Results: The study's primary outcome, protocol adherence, was achieved in 87.5% (35/40) of patients, demonstrating the protocol's feasibility. 27/35 patients (77%) had ASBO resolution with conservative management. Eight patients required surgery, mostly due to lack of improvement after 72 hours of conservative management. Complications were minimal, with only two cases of bronchial aspiration. No patient died within 30 days of conservative management.

Conclusion: This standardized algorithm using pre-defined NGT output values proved feasible and safe, standardizing care and providing structured guidance in clinical decision-making. Larger trials are necessary to confirm efficacy and explore patient-reported outcomes.

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粘连性小肠梗阻治疗算法的可行性和安全性。

本单中心前瞻性队列研究评估了粘连性小肠梗阻（ASBO）患者的结构化管理方案（肠梗阻管理算法方案：I-MAP）的可行性和安全性。方法：在63例ASBO患者中，40例符合纳入标准，并按照I-MAP进行管理，在标准化决策框架内纳入鼻胃管（NGT）输出和水溶性造影剂（WSC）管理。结果：87.5%（35/40）的患者达到了研究的主要结局——方案依从性，证明了方案的可行性。27/35例患者（77%）在保守治疗下ASBO得到缓解。8例患者需要手术，主要是由于72小时保守治疗后缺乏改善。并发症极少，只有2例支气管误吸。保守治疗30天内无患者死亡。结论：采用预定义NGT输出值的标准化算法可行且安全，可规范护理，为临床决策提供结构化指导。需要更大规模的试验来证实疗效并探索患者报告的结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Langenbeck's Archives of Surgery 医学-外科

CiteScore

3.30

自引率

8.70%

发文量

342

审稿时长

4-8 weeks

期刊介绍： Langenbeck''s Archives of Surgery aims to publish the best results in the field of clinical surgery and basic surgical research. The main focus is on providing the highest level of clinical research and clinically relevant basic research. The journal, published exclusively in English, will provide an international discussion forum for the controlled results of clinical surgery. The majority of published contributions will be original articles reporting on clinical data from general and visceral surgery, while endocrine surgery will also be covered. Papers on basic surgical principles from the fields of traumatology, vascular and thoracic surgery are also welcome. Evidence-based medicine is an important criterion for the acceptance of papers.