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Pancreatic necrosis (PN) occurs in approximately 20% of patients with acute pancreatitis and is associated with a mortality rate of 8% to 39%. A common cause of PN-related death is secondary infection of pancreatic or peripancreatic necrotic tissue and subsequent sepsis and multiorgan failure. Treatment of such secondary infections traditionally involved open necrosectomy. However, this approach is associated with a complication rate of 24% to 95% and a mortality rate of 11% to 39%. Alternate treatments include a “step-up” approach in which percutaneous or endoscopic drainage of infected fluid is undertaken to mitigate sepsis, and, then, if clinical improvement is not achieved, minimally invasive retroperitoneal necrosectomy is performed.
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