JOP. J Pancreas (Online) 2008; 9(5):644-648. JOP. Journal of the Pancreas - http://www.joplink.net - Vol. 9, No. 5 - September 2008. [ISSN 1590-8577] 644 CASE REPORT Feasibility of Laparoscopic Distal Spleno-Pancreatectomy Following Previous Necrosectomy. A Case Report Anil K Hemandas 1 , Gaurav Jain 1 , Farina Fong 1 , Brian Stedman 2 , Eleanor Jaynes 3 , Mohammad Abu Hilal 1 1 Hepatobiliary-Pancreatic and Laparoscopic Surgical Unit, 2 Department of Radiology, 3 Department of Pathology; Southampton University Hospital. Southampton, United Kingdom ABSTRACT Context In recent years, laparoscopic approach to distal pancreatectomy has been increasingly favoured following several reports showing reductions in morbidity and hospital stay compared with open surgery. Previous major abdominal surgery is a relative contraindication for most laparoscopic procedures including distal pancreatectomy. Case report We present a case of a young woman in whom we attempted and accomplished safely, a laparoscopic distal pancreatectomy despite having had major pancreatic necrosectomy and discuss the feasibility of this approach. Conclusion It is possible to perform complex laparoscopic pancreatic resections safely in centres with special interest and expertise. INTRODUCTION Laparoscopic pancreatic surgery has been slow to expand due to technical difficulties in accessing the retroperitoneal space, the complex anatomical relationship of the pancreas with the surrounding vessels and the serious morbidities in pancreatic surgery especially pancreatic leak. However, thanks to rapid advances in surgical techniques and instrumentation in recent years, the laparoscopic approach to distal pancreatect- omy is now gaining popularity [1, 2, 3]. To our knowledge, laparoscopic pancreatic resection following previous abdominal surgery has not been a matter of discussion; moreover, there are no reports on laparoscopic pancreatic resection in a patient with previous pancreatic necrosectomy. Previous major abdominal surgery is generally considered a relative contra- indication for most laparoscopic procedures because of technical difficulties due to adhesions and risk of iatrogenic injury [4]. We present a case of a young woman who successfully and safely underwent laparoscopic distal pancreatectomy four years after open pancreatic necrosectomy, for an unusual symptomatic cystic dilatation of the distal pancreas and discuss the feasibility of this approach. CASE REPORT A 37-year-old lady was referred to us for management of a cystic pancreatic lesion and recurrent pancreatitis. Four years ago, she presented with severe gallstones related acute pancreatitis to her local hospital where she underwent open pancreatic necrosectomy and cholecystectomy. During the subsequent years, she had several further attacks of pancreatitis necessitating hospital admissions affecting her quality of life. The pain was associated with food thus affecting her oral