OBJECTIVETo investigate the indication, timing and methods of surgery for acute necrotizing pancreatitis.

METHODSThere were 5 538 patients with acute pancreatitis (AP) were treated in the Union Hospital, Tongji Medical College from January 2005 to December 2014. Of all AP cases, 2 415 patients with acute necrotizing pancreatitis proved by computed tomography, and 732 patients underwent surgical treatment. Among 732 patients with surgical treatment, 439 (60.0%) were males and two hundreds and ninety-three (40.0%) were females. The median age was 45 years, ranging 20-76 years. Two hundreds and eighty-nine cases were treated with minimally invasive debridement and drainage and 684 cases were treated with open debridement.

RESULTSThe cure rate of minimally invasive operation was 16.6% (48/289). The rest of the 241 patients were treated furtherly with open necrosectomy. Among 684 patients with open surgery, 523 patients (76.5%) were infected, and the median time from the onset of symptom to first open operation was 46 d (range 19-205 d). There were 115 patients need to surgery again because of necrotic tissue residual and the reoperation rate was 16.81% (115/684), 684 patients were performed open surgery on average 1.26 times per person. The main postoperative complications were intra-abdominal hemorrhage (37 cases), upper digestive tract fistula (34 cases), colonic fistula (12 cases), gastrointestinal obstruction (29 cases) and pancreatic fistula (83 cases). The overall incidence of complications were 28.5% (195/684). Forty-nine cases died after surgery and the mortality rate was 6.7% (49/732).

CONCLUSIONRational surgical indications and timing of surgical intervention are the key to improve the efficacy of necrotizing pancreatitis, open debridement is still an effective method for necrotizing pancreatitis.