Médecine

Paramédical

Autres domaines


S'abonner

Impact of a procalcitonin-based algorithm on the management of adhesion-related small bowel obstruction - 23/08/17

Doi : 10.1016/j.jviscsurg.2017.01.004 
C. Cossé a, b, c, C. Sabbagh a, b, V. Carroni a, A. Galmiche d, L. Rebibo a, J.-M. Regimbeau a, c, e,
a Department of Digestive and Oncological Surgery, Amiens University Medical Center, Jules Verne University of Picardie, Amiens, France 
b INSERM U1088, Jules Verne University of Picardie, Amiens, France 
c Clinical Research Centre, Amiens University Medical Center and Jules Verne University of Picardie, Amiens, France 
d Department of Biochemistry, Amiens University Medical Center and Jules Verne University of Picardie, Amiens, France 
e EA4294, Jules Verne University of Picardie, Amiens, France 

Corresponding author. Department of Digestive and Oncological Surgery. CHU Sud, avenue René-Laennec, 80054 Amiens cedex 01, France. Tel.: +33 322 088905; fax: +33 322 089733.

Bienvenue sur EM-consulte, la référence des professionnels de santé.
Article gratuit.

Connectez-vous pour en bénéficier!

Summary

Introduction

Adhesion-related small bowel obstruction (ASBO) management is difficult if there are no signs of strangulation or peritonitis when intestinal transit has not been restored. The aim of the present study was to determine the impact of combining a procalcitonin (PCT)-based algorithm with clinical signs on the management of uncomplicated ASBO.

Method

We performed a pilot, retrospective, single-center “before–after” study. During the “before” period (2007 to 2012), patients with uncomplicated ASBO (n=93, the Gastrografin® group) underwent a clinical examination and a Gastrografin® index. During the “after” period (2013 to 2016), patients with uncomplicated ASBO (n=70, the algorithm group) underwent a clinical examination and were assessed with the PCT-based algorithm. The study's primary outcome was the appropriateness of ASBO management. The secondary outcomes were the need for surgery and the time to surgery, the LOS, the morbidity and mortality rates, and the recurrence rate.

Results

The proportion of well-managed patients was higher in the algorithm group than in the Gastrografin® group (86% vs. 47%; P<0.001). The time to surgery (48h vs 72h; P=0.02) and the LOS (4 vs. 6days, P=0.02) were significantly lower in the algorithm group. The need for surgery was similar in both groups (31% vs. 37%, P=0.49). The morbidity (P=0.69), mortality (P=0.82) and recurrence rates (P=0.57) were similar in the two groups.

Conclusion

The use of a PCT-based algorithm is of value in the routine clinical management of ASBO; it reduces the LOS and the time to surgery without increasing the need for surgery.

Le texte complet de cet article est disponible en PDF.

Keywords : Procalcitonin, Adhesion-related small bowel obstruction

Abbreviations : PCT, ASBO


Plan


 This work was presented as an oral communication at the congress of the Indian Association of Surgical Gastroenterology (Pune, October 2015).


© 2017  Publié par Elsevier Masson SAS.
Ajouter à ma bibliothèque Retirer de ma bibliothèque Imprimer
Export

    Export citations

  • Fichier

  • Contenu

Vol 154 - N° 4

P. 231-237 - septembre 2017 Retour au numéro
Article précédent Article précédent
  • Reconstruction after ureteral resection during HIPEC surgery: Re-implantation with uretero-neocystostomy seems safer than end-to-end anastomosis
  • U. Pinar, J.-F. Tremblay, G. Passot, M. Dazza, O. Glehen, J.-J. Tuech, M. Pocard, BIG-RENAPE working group
| Article suivant Article suivant
  • The severity grading of acute cholecystitis following the Tokyo Guidelines is the most powerful predictive factor for conversion from laparoscopic cholecystectomy to open cholecystectomy
  • M. Bouassida, M.F. Chtourou, H. Charrada, S. Zribi, L. Hamzaoui, M.M. Mighri, H. Touinsi

Bienvenue sur EM-consulte, la référence des professionnels de santé.

Mon compte


Plateformes Elsevier Masson

Déclaration CNIL

EM-CONSULTE.COM est déclaré à la CNIL, déclaration n° 1286925.

En application de la loi nº78-17 du 6 janvier 1978 relative à l'informatique, aux fichiers et aux libertés, vous disposez des droits d'opposition (art.26 de la loi), d'accès (art.34 à 38 de la loi), et de rectification (art.36 de la loi) des données vous concernant. Ainsi, vous pouvez exiger que soient rectifiées, complétées, clarifiées, mises à jour ou effacées les informations vous concernant qui sont inexactes, incomplètes, équivoques, périmées ou dont la collecte ou l'utilisation ou la conservation est interdite.
Les informations personnelles concernant les visiteurs de notre site, y compris leur identité, sont confidentielles.
Le responsable du site s'engage sur l'honneur à respecter les conditions légales de confidentialité applicables en France et à ne pas divulguer ces informations à des tiers.