The role of minimally invasive techniques for necrosectomy in acute pancreatitis

Surgical debridement is the “gold standard” for treatment of infected pancreatic and peripancreatic necrosis. However, advances in radiologic imaging, new developments of interventional radiology, and other minimal access interventions have revolutionized the management of many surgical conditions over the past few decades. Consequently, even infected pancreatic necrosis has been successfully treated in selected patients. However, technical feasibility does not obviate sound clinical judgment. We must be cautious in the application of new technologies in the abscence of well-designed clinical trials. Thus, minimally invasive surgery and interventional therapy for infected necrosis should be limited to clinical trials and specific indications in patients who are critically ill and otherwise unfit for conventional surgery.