Small bowel obstruction outcomes according to compliance with the World Society of Emergency Surgery Bologna guidelines - Report - MDSpire

Small bowel obstruction outcomes according to compliance with the World Society of Emergency Surgery Bologna guidelines

  • By

  • Lewis J Kaplan

  • Isidro Martinez-Casas

  • Shahin Mohseni

  • Matteo Cimino

  • Hayato Kurihara

  • Matthew J Lee

  • Gary A Bass

  • SnapSBO Collaborators

  • Agron Dogjani

  • Kastriot Subashi

  • Klevis Doci

  • Joana Spaho

  • Ali Abdulla

  • Sara Ahmed

  • Yusuf AlAnsari

  • Mariam AlKooheji

  • Alaa Marzooq

  • Khaled Nazzal

  • Emir Ahmetašević

  • Zlatan Mehmedović

  • Maja Kovačević

  • Jasminka Mujkanović

  • Peter Svenningsen

  • Marie Peter Møller

  • Gitte Emilje Olsen

  • Abeer Aboalazayem

  • Muhammad Ashrad Awad

  • Mahmoud M A Elfiky

  • Moemen Farouk

  • Mostafa Gad

  • Basma Magdy

  • Peep Talving

  • Edgar Lipping

  • Edgar Lipping

  • Sten Saar

  • Artjom Bahhir

  • Maarja Talviste

  • Vincent Dubuisson

  • Luca Cigagna

  • Luigi Cayre

  • Spyridon Christodoulou

  • Panagiotis Kokoropoulos

  • Ioannis Margaris

  • Maria Papadoliopoulou

  • Theodoros A Sidiropoulos

  • Panteleimon Vassiliu

  • Evangelos Barkolias

  • Pavlos Georgalis

  • Theodosios Kantas

  • Vasiliki Nikolaou

  • Aristeidis Papadopoulos

  • Katerina Tata

  • Stergios Arapoglou

  • Ioannis Gkoutziotis

  • Aikaterini Mpratko

  • Elissavet Symeonidou

  • Stylianos Kykalos

  • Nikolaos Machairas

  • Adam Mylonakis

  • Panagiotis Sakarellos

  • Dimitrios Schizas

  • Michail Vailas

  • Iraklis Anastasiadis

  • Parmenion Patias

  • Koumarelas Konstantinos

  • Mourtarakos Saradis

  • Charles Lee

  • Chloe Spillane

  • Dylan Viani Walsh

  • Nadia Walsh

  • Thomas Noel Walsh

  • Gabriel Orsi

  • Andrew Keane

  • David Kearney

  • Emma de Sousa

  • Michael Sugrue

  • Anne Marie Doyle

  • Robert Fitzsimmons

  • Angus J Lloyd

  • Mohammad Saad Qasim

  • Mashood Ahmed

  • Taylor Jacoby

  • Michael E Kelly

  • Shafagh Khodadi

  • Paul McCormick

  • Éanna J Ryan

  • Mahmoud M Salama

  • Helen Heneghan

  • Cian Davis

  • Odhran K Ryan

  • Sean T Martin

  • Miklosh Bala

  • Michele Altomare

  • Stefano P B Cioffi

  • Andrea Spota

  • Giada Panagini

  • Laura Benuzzi

  • Stefania Cimbanassi

  • Noemi DiFuccia

  • Stefano Manfroni

  • Alan Biloslavo

  • Paola Germani

  • Nicolo de Manzini

  • Manuela Mastronardi

  • Anna Modica

  • Serena Scomersi

  • Gabriele Bellio

  • Luigi Cayre

  • Gaia Altieri

  • Pietro Fransvea

  • Gabriele Sganga

  • Silvia Tedesco

  • Francesca Bunino

  • Sabrina Caspani

  • Daniele DelFabbro

  • Simone Giudici

  • Giulia Mauri

  • Paolo Meneghesso

  • Enrico Ortolano

  • Antonella D'addiego

  • Francesca Di Vittorio

  • Gabriele Bormolini

  • Michele Carlucci

  • Giovanni Pesenti

  • Claudia Tintori

  • Mauro Zago

  • Martina Zambon

  • Simona Meneghini

  • Andrea Mingoli

  • Giulia Duranti

  • Gioia Brachini

  • Pierfrancesco Lapolla

  • Mehdi Hanafi

  • Clara Valdez Cruz

  • Andrea Alfredo Huerta de León

  • Jose García Regalado

  • Pasquale de Jesús Cristiano Nakhal

  • Diego Enrique Rodríguez González

  • Jose Ruiz

  • Salvador Lozada Jimenez

  • Oscar Carlos Delgado

  • Monserrat Reyes Zamorano

  • Anyely Fuertes Muñoz

  • Ademola Adetoyese Adeyeye

  • Ehis Afeikhena

  • Akinola Akinmade

  • Babatunde Mustapha

  • Jaroslav Presl

  • Patrick Rebnegger

  • Bjoern Rudisch

  • Gruenfelder Johanna

  • Rokitte Karin

  • Filipa M CorteReal

  • Jorge A Pereira

  • Joao L Pinheiro

  • Daniela M Pinto

  • Andreia J Santos

  • Andreia M Silva

  • Susana Henriques

  • Joao Melo

  • António Miguel Pereira

  • Antonio Miguel Pereira

  • Ana Margarida Cabral

  • Bruno Dias Couto

  • Barbara Nunes Gama

  • Catarina Santos Rodrigues

  • Mara Nunes

  • Bruno Ribeiro Silva

  • Daniela Tavares

  • Daniela Tavares

  • Toma Mihai

  • Oprea C Valentin

  • Srdjan S Putnik

  • Petar Andjic

  • Marija Djujic

  • Rastislav Filko

  • Vanja Kunkin

  • Andjela Milak

  • Aleksandar Ognjenovic

  • Nebojsa Mitrovic

  • Goran Aleksandric

  • Mihailo Bezmarević

  • Sasa Dragović

  • Milan Jovanović

  • Bosko Milev

  • Miroslav Mitrović

  • Srdjan Petković

  • Valentina Isakovic

  • Nikola Zoran Nikolic

  • Predrag Radic

  • Dragan Luka Vasic

  • Zlatibor M Loncar

  • Dusan D Micic

  • Vladimir R Resanovic

  • Pavle D Vladimir

  • Krstina S Doklestic Vasiljev

  • Ljiljana Velibor Milic

  • Vladica Velibor Cuk

  • Jovan Todor Juloski

  • Radisav Slavoljub Radulovic

  • Dragana Dragan Arbutina

  • Jacobo Trebol

  • Manuel Torres-Jurado

  • Andres J Valera-Montiel

  • Francisco E Blanco-Antona

  • Beatriz de Andrés-Asenjo

  • Maria Ruiz-Soriano

  • Tania Gómez-Sanz

  • Andrea Vázquez-Fernández

  • Juan Beltran de Heredia

  • Cristina Rey-Valcárcel

  • Monica Ballón-Bordon

  • Maria Pérez-Díaz

  • Maria Dolores Sanchez-Rodriguez

  • Jose David Gonzalez-Esteban

  • Celia Alegre Nevado

  • Ricardo Montenegro Romero

  • Andrea Campos-Serra

  • Raquel Gracia-Roman

  • Heura Llaquet-Bayo

  • Anna Muñoz-Campaña

  • Giulia Vitiello

  • Lorena Apodaca Murguiondo

  • Inigo Augusto Ponce

  • Amaia Garcia Dominguez

  • Aintzane Lizarazu Perez

  • Elena Sagarra Cebolla

  • Mónica García Aparicio

  • Paloma Garaulet González

  • Benito Miguel Josa Martínez

  • Miriam Fraile Vasallo

  • Mónica MengualBallester

  • Isabel Andrés Lucas Zamorano

  • Jose Martinez Moreno

  • Manuel Luis Buitrago Ruiz

  • Clara Piñera Morcillo

  • Alberto Díaz García

  • Hanna Hernández Oaknin

  • Maria Pellicer Barreda

  • Jennifer Amparo García Niebla

  • Antonio Pérez Álvarez

  • Diego Cordova

  • Laura Jiménez

  • Fernando Mendoza

  • Cristina Vera

  • Alberto Vilar Tabanera

  • María de los Ángeles Gil-Olarte Márquez

  • José Antonio López-Ruiz

  • Mª Estela Romero-Vargas

  • Julio Reguera-Rosal

  • Alberto García-García

  • Beatriz Marenco de la Cuadra

  • Eduardo Perea del Pozo

  • Virginia Duran Muñoz

  • Felipe Pareja Ciuró

  • Ainoa Benavides dos Santos

  • Ernest Bombuy

  • Anna G-Monferrer

  • Sandra López Gordo

  • José Guerra

  • Vanessa Sojo

  • Begona De Soto

  • Aaron Roman

  • Ana María González-Castillo

  • Elena Manzo

  • Estela Membrilla-Fernandez

  • Amalia Pelegrina-Manzano

  • Simone Cremona

  • Alexander Forero-Torres

  • Santiago Valderrabano

  • Francisco Reinoso Olmedo

  • Fuad Lopez Fernandez

  • Aitor Landaluce-Olavarria

  • Jon Barrutia- Leonardo

  • Alba Garcia-Trancho

  • Melania Gonzalez-De Miguel

  • Izaskun Markinez-Gordobil

  • Maryam Makki

  • Dana Altamimi

  • Sadhika Vinod

  • Olga Rutka

  • John V Taylor

  • M Denton

  • S Gourgiotis

  • R Ravi

  • A J Ribbits

  • Jared Wohlgemut

  • Shehryar Rangana Khan

  • Christopher Leiberman

  • Sabreen P Elbakri

  • Charlie A Edgar

  • Conor Magee

  • Oluwaseun Oyekan

  • Mehwish Ansar

  • Jeremy Wilson

  • Rahel Rashid

  • Deborah Atwell

  • Joshua Cassedy

  • Brianna Gabriel

  • William Hoff

  • Shyam Murali

  • Anna E Garcia Whitlock

  • Carolyn Susman

  • Sarah Barnett

  • Emily Ertmann

  • Camden DeSanctis

  • Pavel Karasek

  • Nathan Klingensmith

  • Dale F Butler

  • Brandon Bruns

  • Ankeeta Mehta

  • Vanessa Nomellini

  • Keyus Patel

  • Anthony Tannous

  • April 18, 2025

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Clinical Report: Outcomes of Small Bowel Obstruction and Bologna Guideline Adherence

Overview

This prospective multicentre study evaluated adherence to the World Society of Emergency Surgery (WSES) Bologna guidelines in managing adhesive small bowel obstruction (SBO). Findings demonstrated that patients whose care fully complied with the guidelines experienced shorter hospital stays and higher rates of optimal outcomes compared to partial or non-compliant care.

Background

Small bowel obstruction is a frequent surgical emergency often caused by adhesions, leading to significant morbidity and healthcare resource use. The WSES Bologna guidelines provide evidence-based recommendations for diagnosis, non-operative management, surgery, and postoperative care of adhesive SBO. Despite these guidelines, variability in clinical practice and resource limitations may hinder their adoption, potentially affecting patient outcomes. Understanding the impact of guideline adherence can inform strategies to improve care and reduce complications.

Data Highlights

Patient GroupNumber (%)Mean LOS (days)Optimal Outcomes (%)Full Guideline Compliance (%)
Successful NOM561 (57.1%)5.3 (±9.0)61.0%17.2%
NOM after unsuccessful trial (NOM-T)224 (22.8%)12.9 (±11.4)16.1%10.1%
Direct to Surgery (DTS)197 (20.1%)7.7 (±8.0)37.6%0.4%

Key Findings

  • Among 982 patients with adhesive SBO, 57.1% were successfully managed non-operatively (NOM), 22.8% underwent surgery after an unsuccessful NOM trial, and 20.1% proceeded directly to surgery.
  • Mean hospital length of stay was shortest in the successful NOM group (5.3 days) and longest in the NOM-T group (12.9 days), with significant differences (P < 0.001).
  • Optimal outcomes (LOS ≤5 days, no complications, no 30-day readmission) were achieved in 61.0% of successful NOM patients, 16.1% of NOM-T patients, and 37.6% of DTS patients (P < 0.001).
  • Full compliance with Bologna guidelines was low overall: 17.2% in successful NOM, 10.1% in NOM-T, and 0.4% in DTS groups.
  • Patients receiving care aligned with the Bologna guidelines had shorter LOS and higher rates of optimal outcomes, highlighting the benefits of guideline adherence.
  • Barriers to guideline adoption include resource limitations and variability in clinical practice across healthcare settings.

Clinical Implications

Clinicians should strive to adhere closely to the WSES Bologna guidelines when managing adhesive SBO to improve patient outcomes and reduce hospital length of stay. Implementation strategies that address local resource constraints and practice variability are essential to enhance guideline adoption. Early identification of patients suitable for non-operative management and timely surgical intervention when indicated can optimize recovery.

Conclusion

Adherence to the Bologna guidelines in adhesive SBO management is associated with improved clinical outcomes and shorter hospital stays. Addressing barriers to guideline implementation is critical to translating evidence into practice and enhancing patient care.

References

  1. World Society of Emergency Surgery (WSES) Bologna Guidelines -- Outcomes of Small Bowel Obstruction Based on Adherence

Original Source(s)

Small bowel obstruction outcomes according to compliance with the World Society of Emergency Surgery Bologna guidelines

  • by Lewis J Kaplan, Isidro Martinez-Casas, Shahin Mohseni, Matteo Cimino, Hayato Kurihara, Matthew J Lee, Gary A Bass, SnapSBO Collaborators, Agron Dogjani, Kastriot Subashi, Klevis Doci, Joana Spaho, Ali Abdulla, Sara Ahmed, Yusuf AlAnsari, Mariam AlKooheji, Alaa Marzooq, Khaled Nazzal, Emir Ahmetašević, Zlatan Mehmedović, Maja Kovačević, Jasminka Mujkanović, Peter Svenningsen, Marie Peter Møller, Gitte Emilje Olsen, Abeer Aboalazayem, Muhammad Ashrad Awad, Mahmoud M A Elfiky, Moemen Farouk, Mostafa Gad, Basma Magdy, Peep Talving, Edgar Lipping, Edgar Lipping, Sten Saar, Artjom Bahhir, Maarja Talviste, Vincent Dubuisson, Luca Cigagna, Luigi Cayre, Spyridon Christodoulou, Panagiotis Kokoropoulos, Ioannis Margaris, Maria Papadoliopoulou, Theodoros A Sidiropoulos, Panteleimon Vassiliu, Evangelos Barkolias, Pavlos Georgalis, Theodosios Kantas, Vasiliki Nikolaou, Aristeidis Papadopoulos, Katerina Tata, Stergios Arapoglou, Ioannis Gkoutziotis, Aikaterini Mpratko, Elissavet Symeonidou, Stylianos Kykalos, Nikolaos Machairas, Adam Mylonakis, Panagiotis Sakarellos, Dimitrios Schizas, Michail Vailas, Iraklis Anastasiadis, Parmenion Patias, Koumarelas Konstantinos, Mourtarakos Saradis, Charles Lee, Chloe Spillane, Dylan Viani Walsh, Nadia Walsh, Thomas Noel Walsh, Gabriel Orsi, Andrew Keane, David Kearney, Emma de Sousa, Michael Sugrue, Anne Marie Doyle, Robert Fitzsimmons, Angus J Lloyd, Mohammad Saad Qasim, Mashood Ahmed, Taylor Jacoby, Michael E Kelly, Shafagh Khodadi, Paul McCormick, Éanna J Ryan, Mahmoud M Salama, Helen Heneghan, Cian Davis, Odhran K Ryan, Sean T Martin, Miklosh Bala, Michele Altomare, Stefano P B Cioffi, Andrea Spota, Giada Panagini, Laura Benuzzi, Stefania Cimbanassi, Noemi DiFuccia, Stefano Manfroni, Alan Biloslavo, Paola Germani, Nicolo de Manzini, Manuela Mastronardi, Anna Modica, Serena Scomersi, Gabriele Bellio, Luigi Cayre, Gaia Altieri, Pietro Fransvea, Gabriele Sganga, Silvia Tedesco, Francesca Bunino, Sabrina Caspani, Daniele DelFabbro, Simone Giudici, Giulia Mauri, Paolo Meneghesso, Enrico Ortolano, Antonella D'addiego, Francesca Di Vittorio, Gabriele Bormolini, Michele Carlucci, Giovanni Pesenti, Claudia Tintori, Mauro Zago, Martina Zambon, Simona Meneghini, Andrea Mingoli, Giulia Duranti, Gioia Brachini, Pierfrancesco Lapolla, Mehdi Hanafi, Clara Valdez Cruz, Andrea Alfredo Huerta de León, Jose García Regalado, Pasquale de Jesús Cristiano Nakhal, Diego Enrique Rodríguez González, Jose Ruiz, Salvador Lozada Jimenez, Oscar Carlos Delgado, Monserrat Reyes Zamorano, Anyely Fuertes Muñoz, Ademola Adetoyese Adeyeye, Ehis Afeikhena, Akinola Akinmade, Babatunde Mustapha, Jaroslav Presl, Patrick Rebnegger, Bjoern Rudisch, Gruenfelder Johanna, Rokitte Karin, Filipa M CorteReal, Jorge A Pereira, Joao L Pinheiro, Daniela M Pinto, Andreia J Santos, Andreia M Silva, Susana Henriques, Joao Melo, António Miguel Pereira, Antonio Miguel Pereira, Ana Margarida Cabral, Bruno Dias Couto, Barbara Nunes Gama, Catarina Santos Rodrigues, Mara Nunes, Bruno Ribeiro Silva, Daniela Tavares, Daniela Tavares, Toma Mihai, Oprea C Valentin, Srdjan S Putnik, Petar Andjic, Marija Djujic, Rastislav Filko, Vanja Kunkin, Andjela Milak, Aleksandar Ognjenovic, Nebojsa Mitrovic, Goran Aleksandric, Mihailo Bezmarević, Sasa Dragović, Milan Jovanović, Bosko Milev, Miroslav Mitrović, Srdjan Petković, Valentina Isakovic, Nikola Zoran Nikolic, Predrag Radic, Dragan Luka Vasic, Zlatibor M Loncar, Dusan D Micic, Vladimir R Resanovic, Pavle D Vladimir, Krstina S Doklestic Vasiljev, Ljiljana Velibor Milic, Vladica Velibor Cuk, Jovan Todor Juloski, Radisav Slavoljub Radulovic, Dragana Dragan Arbutina, Jacobo Trebol, Manuel Torres-Jurado, Andres J Valera-Montiel, Francisco E Blanco-Antona, Beatriz de Andrés-Asenjo, Maria Ruiz-Soriano, Tania Gómez-Sanz, Andrea Vázquez-Fernández, Juan Beltran de Heredia, Cristina Rey-Valcárcel, Monica Ballón-Bordon, Maria Pérez-Díaz, Maria Dolores Sanchez-Rodriguez, Jose David Gonzalez-Esteban, Celia Alegre Nevado, Ricardo Montenegro Romero, Andrea Campos-Serra, Raquel Gracia-Roman, Heura Llaquet-Bayo, Anna Muñoz-Campaña, Giulia Vitiello, Lorena Apodaca Murguiondo, Inigo Augusto Ponce, Amaia Garcia Dominguez, Aintzane Lizarazu Perez, Elena Sagarra Cebolla, Mónica García Aparicio, Paloma Garaulet González, Benito Miguel Josa Martínez, Miriam Fraile Vasallo, Mónica MengualBallester, Isabel Andrés Lucas Zamorano, Jose Martinez Moreno, Manuel Luis Buitrago Ruiz, Clara Piñera Morcillo, Alberto Díaz García, Hanna Hernández Oaknin, Maria Pellicer Barreda, Jennifer Amparo García Niebla, Antonio Pérez Álvarez, Diego Cordova, Laura Jiménez, Fernando Mendoza, Cristina Vera, Alberto Vilar Tabanera, María de los Ángeles Gil-Olarte Márquez, José Antonio López-Ruiz, Mª Estela Romero-Vargas, Julio Reguera-Rosal, Alberto García-García, Beatriz Marenco de la Cuadra, Eduardo Perea del Pozo, Virginia Duran Muñoz, Felipe Pareja Ciuró, Ainoa Benavides dos Santos, Ernest Bombuy, Anna G-Monferrer, Sandra López Gordo, José Guerra, Vanessa Sojo, Begona De Soto, Aaron Roman, Ana María González-Castillo, Elena Manzo, Estela Membrilla-Fernandez, Amalia Pelegrina-Manzano, Simone Cremona, Alexander Forero-Torres, Santiago Valderrabano, Francisco Reinoso Olmedo, Fuad Lopez Fernandez, Aitor Landaluce-Olavarria, Jon Barrutia- Leonardo, Alba Garcia-Trancho, Melania Gonzalez-De Miguel, Izaskun Markinez-Gordobil, Maryam Makki, Dana Altamimi, Sadhika Vinod, Olga Rutka, John V Taylor, M Denton, S Gourgiotis, R Ravi, A J Ribbits, Jared Wohlgemut, Shehryar Rangana Khan, Christopher Leiberman, Sabreen P Elbakri, Charlie A Edgar, Conor Magee, Oluwaseun Oyekan, Mehwish Ansar, Jeremy Wilson, Rahel Rashid, Deborah Atwell, Joshua Cassedy, Brianna Gabriel, William Hoff, Shyam Murali, Anna E Garcia Whitlock, Carolyn Susman, Sarah Barnett, Emily Ertmann, Camden DeSanctis, Pavel Karasek, Nathan Klingensmith, Dale F Butler, Brandon Bruns, Ankeeta Mehta, Vanessa Nomellini, Keyus Patel, Anthony Tannous

  • April 18, 2025

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