Analysis of results of laparoscopic surgeries in 226 patients for acute adhesive small bowel obstruction from 2000 to 2010 years is presented. Number of conversions and intraoperative complications are proved to be related to a variety of clinical factors. The most favorable conditions for laparoscopic adhesiolysis are less than two surgeries in the past medical history, diameter of the bowel not more than 40 mm and solitary adhesions as cause of the ileus. Strangulated intestinal obstruction is not contraindication to laparoscopic procedures. However it is approachable in case of absence of additional adverse factors - significant bowel distension, massive adhesions and necrosis. Completeness of adhesiolysis in the postoperative period is confirmed by contrast enterography. Delayed contrast evacuation to the colon speaks for persistent obstruction and dictates revision of the abdominal cavity. Balanced approach to defining the indications enabled to emphasize "favorable" group of patients for laparoscopic surgeries in acute adhesive small bowel obstruction thus reducing rate of postoperative complications and lethality to 10 and 0.83%, respectively.