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Introduction: Laparoscopic lysis of adhesions (LLOA) for small bowel obstruction (SBO) has not increased in prevalence as other minimally invasive procedures such as cholecystectomy, herniorrhaphy, and appendectomy have. Loss of laparoscopic workspace and friability of distended bowel increase both the difficulty and risk of this procedure. This study examines the prevalence, safety and efficacy of LLOA and open lysis of adhesions (OLOA).Methods: University HealthSystem Consortium (UHC) is an alliance of more than 100 academic medical centers and affiliate hospitals. UHC’s Clinical DataBase/Resource Manager (CDB/RM) allows comparison of patient-level risk-adjusted outcomes for performance improvement. This study is a multi-center, retrospective outcome analysis of discharge data of adult patients with small bowel obstruction secondary to adhesions who undergo LLOA or OLOA. Main outcome measures analyzed were mortality, morbidity, 30-day readmission, intensive care unit (ICU) admission, length of stay (LOS) and cost. Results: 20,514 patients with SBO underwent LLOA (n=2940) or OLOA (n=17,574) over a 45 month period between October 2007 and November 2010. LLAO represented 14.3% of all operative treatments. Comparing postoperative outcomes LLOA showed lower mortality (1.12% LLOA vs. 4.36% OLOA; p<0.0001), lower morbidity (5.65% LLOA vs. 15.77% OLOA; p<0.0001), reduced length of stay (7.99 ± 10.84 days LLOA vs. 15.77 ± 17.56 days OLOA; p<0.0001), reduced costs ($21,053 ±13,665 LLOA vs. $39,453 ± 26,564 OLOA; p<0.0001), lower 30-day readmission rate (6.21% LLOA vs. 8.51% OLOA; p<0.001), and lower ICU admission rate (11.97% LLOA vs. 36.27% OLOA; p<0.0001). Higher risk patients with major/extreme severity of illness scores represented a significantly higher portion of the OLOA group (23.7% LLOA vs. 46.6% OLOA; p<0.001).Conclusion: LLOA represents a small portion of operative treatment for SBO with the vast majority of operative treatments utilizing open technique. OLOA patients were higher risk than LLOA patients. However, when LLOA is performed it is a safe and efficacious option. LLOA should be considered as treatment of SBO when the surgeon is comfortable with the technique and the patient is a good candidate (no evidence of sepsis, laparoscopic workspace can be created, and adhesions amenable to laparoscopic lysis).