The laparoscopic infracolic approach has been used to treat eight patients with large pseudocysts. Early uncomplicated resolution was observed in seven and delayed resolution (at 3 months) in one. The median hospital stay was 6 days (range 5 to 15). The same approach was used to perform necrosectomy and postoperative lavage of the infected lesser sac in three patients with infected pancreatic necrosis. Two of these patients recovered without further treatment; however, the third patient required further open necrosectomy but survived after a prolonged illness complicated by pancreatic ascitis. The infracolic laparoscopic approach seems to be a useful technique for internal drainage of pancreatic pseudocysts. Its use for necrosectomy, drainage, and irrigation of the lesser sac merits further evaluation.