LAPAROSCOPIC CHOLECYSTECTOMY AFTER PANCREATIC DEBRIDEMENT

Background: Pancreatic debridement is a lifesaving operation in patien ts with severe acute pancreatitis and pancreatic or peripancreatic nec rosis. Even in the presence of gallstones, cholecystectomy may be avoi ded during the procedure, but definitive treatment of the stones is ne eded at a later stage. Methods: Five patients (median age 58 years) un derwent laparoscopic cholecystectomy, at a median time interval of 15 months, after pancreatic debridement via a dome-shaped upper abdominal incision for seven acute pancreatitis. The use of alternative methods for primary access, additional cannulae to enable division of adhesio ns, the harmonic scalpel, and the fundus first technique made the lapa roscopic approach possible and safe. Results: The median operating tim e was 130 min. Four patients were discharged home the first or second postoperative day. One patient required a ''mini-laparotomy'' for drai nage of a periumbilical hematoma and was discharged on the 13th day. C onclusions: Laparoscopic cholecystectomy can be considered an effectiv e and safe approach for the treatment of gallstones in patients who ha ve undergone pancreatic debridement.