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RECURRENT ASBO
ASBO : Adhesive Small Bowel Obstruction
Operative management :
• Laparoscopic exploration
• Open approach
Levrant SG, Bieber E, Barnes R : Risk of anterior abdominal wall adhesions increases
with number and type of previous laparotomy.
Van Der Krabben AA, Dijkstra FR, Niuwenhuijzen M, et al.: Morbidity and mortality of
inadvertent enterotomy during adhesiolysis.
Inflammation Plasminogen
tPA Plasmin
Proinflammatory uPA
cytokines
Tissue factor pathway
inhibitor PAI-1
α2-antiplasmin
Tissue factor
Protein C system
AT-III
Fibrinogen
Coagulation
system
Main interactions between the inflammatory, coagulatory and fibrinolytic systems that play a role in the pathogenesis of adhesions,
tPA, tissue plasminogen activator; uPA, urokinase plasminogen activator; PAI, plasminogen activator inhibitor; AT, antithrombin
Hellebrekers B.W.J, Koositra T. Pathogenesis of postoperative adhesion formation. Br. J. Surg 2011: 98: 1503-1516
Surgical intervention : laparotomi or
laparoscopy. Which one?
Is the “one size fits all” approach fit for the
ASBO management?
LAPAROSCOPIC INTERVENTION
Peschaud F, Alves A, Berdah S, Kianmanesh R, Lurent C, MA Brut JY, Mariette C, Meurette G, Pirro N,
Veryrie N, Slim K: Indicazioni alla laparoscopia in chirurgia generale e digestiva.
Franklin ME, Gonzalez JJ, Miter DB, Glas JL, Paulson D: Laparoscopic diagnosis and treatment of
intestinal obstruction.
Sato Y, Ido K, Kumagai M, et al.: Laparoscopic adhesiolysis for recurrent small bowel obstruction: long-term
follow-up.
Chosidow D, Johanet H, Montario T, et al.: Laparoscopy for acute smallbowel obstruction secondary to adhesions.
PAI
Peritoneal adhesion index : by ascribing to each abdomen area an adhesion related score as indicated, the
sum of the scores will result in the PAI.
Di Saverio et al. World Journal of Emergency Surgery 2013 8:42.
CONCLUSION