A step-up approach or open necrosectomy for necrotising pancreatitis.  N Engl J Med 2010; 362: 1491-1502.

Published: 2nd September 2010

Authors: Van Santvoort HC, Besselink MG, Bakker OJ, Hofker HS, Boermeester MA, Dejong CH et al. et al.

Conclusion

Thirty-five per cent of those randomized to the no initial surgery group were treated by percutaneous drainage alone, in this trial that included 88 patients. The step-up group had fewer complications including death (risk ratio 0.57, 95 per cent confidence interval 0.38 to 0.87, P=0.006), and lower rates of subsequent diabetes and incisional hernia.

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