Previous find more midline laparotomy incision and multiple previous episodes of ASBO with estimated PAI score of > =2 in more than 3 abdominal regions, were significantly associated in this series with increased risk of conversion and longer operative times. Prevention We do need to prevent ASBO (LOE 2b GoR B). In view of the incidence of adhesions and recurrence rates of ASBO as well as of the magnitude of the medical problems and financial burden related to adhesions, prevention or reduction of postoperative

adhesions in an important priority. Hyaluronic acid-carboxycellulose membrane and icodextrin are able to reduce adhesions (respectively LOE 1a GOR A and LOE 1b GOR A). Icodextrin may reduce the risk of re-obstruction for ASBO (LOE 1 b GOR A). Hyaluronic acid-carboxycellulose can not reduce the need of surgery for ASBO (LOE 1a GOR A). Most of Peptide 17 order the available literature is based on gynecologic patients. For general surgical

patients no recommendations or guidelines exist. Any prevention strategy should be safe, effective, practical, and cost effective. A combination of prevention strategies might be more effective [78]. In the same review the authors recommend a laparoscopic approach if possible, the use of bioabsorbable barriers, a meticulous hemostasis, XAV-939 mw avoiding excessive tissue dissection and ischemia and reducing remaining surgical material [78]. In the long term follow up study from Fevang et al. [79] the surgical treatment itself decreased the risk of future admissions

for ASBO, even though the risk of new surgically treated ASBO episodes was the same regardless of the method of treatment (surgical vs conservative). Intraoperative techniques such as avoiding unnecessary peritoneal dissection, avoiding spillage of intestinal contents or gallstones [80], and the use of starch-free gloves [81–83] are basic principles that should be applied to all patients. In most abdominal procedures the laparoscopic approach is associated with a significantly lower incidence of adhesive SBO or adhesion-related re-admission [79, 83]. There is some class I evidence in obstetrics supporting the theory that from suturing the peritoneum increases the risk of adhesions [84]. Concerning mechanical barriers no progresses has been made in the last 6 years. The authors remain convinced that the absorbable adhesion barrier Interceed reduces the incidence of adhesion formation following laparoscopy and laparotomy [85–90]. Gore-Tex may be superior to Interceed in preventing adhesion formation but its usefulness is limited by the need for suturing and later removal [91]. There was no evidence of effectiveness of Seprafilm and Fibrin sheet in preventing adhesion formation [92–99]. Chemical/fluid agents have the theoretical advantage of covering more potential sites of adhesion formation than mechanical barriers. In the newest P.O.P.A. study Catena et al. randomized 91 patients to have 2000 cc of icodextrin 4% and 90 to have the traditional treatment.