Laparoscopy is not generally accepted as an effective, advantageous alternative to formal laparotomy for abdominal emergencies. Its use in patients with previous surgery and intestinal obstruction is often debatable. A retrospective study was performed to analyse the results of the laparoscopic approach for acute small-bowel obstruction in terms of efficacy and safety. From January 2000 to December 2003, 44 non-consecutive patients underwent laparoscopic surgery for radiologically documented small-bowel obstruction. Thirty-nine (89%) had undergone previous abdominal operations (mean number of laparotomies: 2; range 1-5). Twelve were men and 32 women (mean age: 57 years; range 13-91). We retrospectively reviewed the patient data, analysing operative time, need for accessory incision or conversion, length of hospital stay, and intraoperative and postoperative morbidity and mortality. The aetiology was established in 40 patients (91%), and the procedures were completed laparoscopically in 28/44. Mean operative time was 58 min (range 25-160). Six patients required an accessory target incision and 10 patients were converted to formal laparotomy. The reasons for conversion were extent of adhesions (n = 3), problems with laparoscopic view (n = 2), gangrenous bowel (n = 2), locally advanced colon cancer (n = 1), haemoperitoneum (n = 1), and diffuse peritonitis (n = 1). The mean hospital stay was 6 days (range 2-28). Postoperative mortality and morbidity were 2% and 16%, respectively. In conclusion, this study suggest that laparoscopy should be considered early in the clinical course of patients presenting with acute small-bowel obstruction. In most patients definitive treatment is possible, effective and safe, thus justifying the early laparoscopic approach.