Objective: The objective of the study was to evaluate the safety and benefit of laparoscopic management of adhesive small bowel obstruction in order to establish an optimal operative strategy for those patients. Methods: Between April 2012 to September 2014, our study included 56 patients who presented with acute adhesive small bowel obstruction required surgical intervention. We performed laparoscopy for all patients and performed laparoscopic adhesiolysis whenever possible (LAP Group). Otherwise we converted to open surgery (CONV Group) and we compared the outcome of the two groups and evaluated the risk and benefit of initial laparoscopy. Results: 56 patients were enrolled in this study. Laparoscopic techniques (LAP) alone were successfully used to complete 40 cases (73%). Sixteen patients (28%) were converted to open surgery through midline laparotomies. A single band was identified in 38 patients. Complications were comparable between the two groups however the laparoscopic cases benefited from shorter operative times, fewer wound complications (infection/hernia), quicker recovery, shorter hospital stay, and less pain. Conclusion: Laparoscopy has a valuable role for cases presented with adhesive small bowel obstruction, specifically for those patients with a postoperative single band causing obstruction. So, most patients with adhesive intestinal obstruction are candidates for laparoscopy. A significant number of patients will be spared a large laparotomy incision.