Parveen 2009.

Methods	Retrospective case series
Participants	56 patients presenting to 3 surgical units with partial or complete obstruction on a background of ovarian cancer from March 1998 to April 2009
Interventions	Trial of conservative management to all patients first: IV fluids, anti‐spasmodics, nasogastric tube, nil by mouth 22 patients: conservative management successful 30 patients: conservative management unsuccessful and proceeded to laparotomy. Specifically: resection and anastomosis 9; bypass surgery 7; colostomy 3; Hartmann procedure 1; adhesiolysis 8; open/close 2 (advanced abdominal malignancy) 4 patients: conservative management unsuccessful but laparotomy not done due to uncontrolled ascites and cachexia
Outcomes	Conservative treatment: sufficient 39% (22/56) Surgical treatment "successful", i.e. symptomatic relief and return of bowel function: 26.7% (8/30) Postoperative mortality: 40% (12/30): mean survival after operation 4.2 months (range 2 to 6 months) Postoperative complications: 86.6% (26/30): wound infection 77% (22/30); UTI 23% (6/30); intra‐abdominal abscess 15% (4/30); burst abdomen 7.6% (2/30); enterocutaneous fistula 7.6% (2/30); pneumonia 7.6% (2/30); DVT 7.6% (2/30)
Notes	8 of the 30 surgical patients had lysis of adhesions
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	High risk	"Laparotomy was done if obstruction was not relieved by conservative treatment."
Allocation concealment (selection bias)	High risk	"Laparotomy was done if obstruction was not relieved by conservative treatment."
Blinding (performance bias and detection bias) All outcomes	High risk	"The record of all patients admitted in all three surgical units of Ayub Teaching Hospital from March 1998 to April 2008 with a diagnosis of intestinal obstruction were reviewed."
Blinding of participants and personnel (performance bias) All outcomes	High risk	"The record of all patients admitted in all three surgical units of Ayub Teaching Hospital from March 1998 to April 2008 with a diagnosis of intestinal obstruction were reviewed."
Blinding of outcome assessment (detection bias) All outcomes	High risk	"The record of all patients admitted in all three surgical units of Ayub Teaching Hospital from March 1998 to April 2008 with a diagnosis of intestinal obstruction were reviewed."
Selective reporting (reporting bias)	High risk	All patients accounted for Results not reported according to surgical intervention 8 patients underwent surgery for non‐malignant obstruction and were included in the outcomes