Summary. Introduction. According to the opinion of a number of experts, acute biliary pancreatitis should be considered a combination of acute pancreatitis with chronic or acute diseases of the biliary tract. Aim. To assess intraoperative morphological changes during laparoscopy in patients with acute biliary pancreatitis. Materials and methods. We treated 65 patients with acute biliary pancreatitis who had isolated cholecystolithiasis. Forty-two patients had acute calculous cholecystitis, twenty-three patients had chronic calculous cholecystitis. All patients underwent laparoscopy, which included diagnostic and treatment stages. Results. Signs of acute biliary pancreatitis were: serous fluid (6.2 %), fibrinous fluid (10.8 %), hemorrhagic fluid (41.5 %), fatty spots (7.7 %), mesenteric hemorrhagic edema of the large intestine (64.6 %), pancreas edema (23.1 %), omentum edema (50.8 %), vitreous edema of the hepatoduodenal ligament (36.9 %), enlarged gallbladder (60.0 %), destructive acute cholecystitis (9.2 %). When the head of the pancreas was damaged, we observed hemorrhagic fluid, hepatoduodenal ligament edema, an enlarged gallbladder, and acute cholecystitis. When the body of the pancreas was damaged, we observed serous fluid, fatty spots, mesenteric edema of the large intestine, and parapancreatic infiltrate. In the inflammatory process of the pancreas tail, we often observed fibrinous fluid in the abdominal cavity.