2.3 Surgical management of severe acute pancreatitis
Open necrosectomy was the historical standard, with mortality reported between 23 % and 38 % across high-volume centers[1][2]. The minimally invasive step-up approach reduced new-onset multi-organ failure by an absolute 21 % (95 % CI 8–34, p = 0.002)[3].
Subsequent meta-analyses, however, found no statistically significant difference in 90-day mortality[4], suggesting that the benefit derives from avoided complications rather than survival per se.