Between May 1975 and December 1991, a total of 208 patients were opera
ted upon for severe acute necrotic pancreatitis. The decision whether
to operate on patients with clinical and biologic aggravation despite
particularly sustained intensive care was taken after evaluation of ul
trasound and CT scan images. Combining pancreatic body resections and
necrotic tissue excision with laparostomy and staged lavage drainage r
educed global mortality rate from 49.2 to 16.4 p. cent. The criteria u
sed for determining the indication for surgical intervention, and the
technical and tactical operative procedures applied allowing this impr
ovement, are described and discussed.