215 Title: An Overview of Adhesional Small Bowel Obstruction Management Across Two High-Volume Tertiary Centres in the North West of England

This study is a retrospective audit conducted in November and December 2022 across two high volume tertiary centres in Liverpool (Royal Liverpool University Hospital and Aintree Major Trauma Centre), aiming to evaluate the local diagnostic and therapeutic approaches to ASBO, benchmarked against the established Bologna ASBO Working Group Guidelines of 2017 and the NASBO recommendations. Our audit encompassed 22 patients, with a slight female predominance (59.1%), and an average age of 63.5 years. The audit revealed several critical insights, including a tendency to over-utilise abdominal X-Ray contrary to current WSES (Bologna) recommendations, suboptimal utilisation of water-soluble contrast agents in conjunction with CT imaging for ASBO diagnosis and management (36.4% adherence), delayed timing to cross-sectional imaging (averaging 11.7 hours from suspicion to imaging) and delayed time to surgical intervention (mean duration of 102.6 hours in emergency, and up to 135 hours in semi-emergency scenarios), inconsistent biochemical monitoring with notably deficient lactate surveillance (16.7%), delayed implementation of parenteral nutrition (36.4%), and a mortality rate of 13.6%, which notably exceeds the Bologna report figures. These findings have catalysed a comprehensive re-evaluation and restructuring of our local protocols for ASBO treatment and management. Future directives include expedited diagnosis through prompt CT scanning integrated with water-soluble contrast agents at the point of entry, advocacy for both conservative and surgical intervention as clinically indicated, the promotion of a multidisciplinary approach with early involvement of dietitian team and establishment of TPN, and an overarching goal to curtail mortality rates associated with ASBO.