Laparoscopic cholecystectomy after pancreatic debridement.

BACKGROUND

Pancreatic debridement is a lifesaving operation in patients with severe acute pancreatitis and pancreatic or peripancreatic necrosis. Even in the presence of gallstones, cholecystectomy may be avoided during the procedure, but definitive treatment of the stones is needed at a later stage.

METHODS

Five patients (median age 58 years) underwent laparoscopic cholecystectomy, at a median time interval of 15 months, after pancreatic debridement via a dome-shaped upper abdominal incision for severe acute pancreatitis. The use of alternative methods for primary access, additional cannulae to enable division of adhesions, the harmonic scalpel, and the fundus first technique made the laparoscopic approach possible and safe.

RESULTS

The median operating time was 130 min. Four patients were discharged home the first or second postoperative day. One patient required a "mini-laparotomy" for drainage of a periumbilical hematoma and was discharged on the 13th day.

CONCLUSIONS

Laparoscopic cholecystectomy can be considered an effective and safe approach for the treatment of gallstones in patients who have undergone pancreatic debridement.