Objective To evaluate the results of debridement and closed packing fo
r necrotizing pancreatitis and to determine the optimal timing of surg
ical intervention based on patient outcomes. Methods Between February
1990 and November 1996, 64 consecutive patients with necrotizing pancr
eatitis were treated with necrosectomy followed by closed packing of t
he cavity with stuffed Penrose and closed suction drains. The mean APA
CHE II score immediately before surgery was 9, and 31% of the patients
had organ failure. Patients were stratified with an outcome score bas
ed on death and major complications; this was correlated with the timi
ng of surgical intervention. The data were then subjected to cut-point
analysis by sequential group comparison. Results Patients underwent s
urgery a median of 31 days after diagnosis. Fifty-six percent had infe
cted necrosis. The mortality rate was 6.2% and was no different in inf
ected or sterile necrosis. Eleven patients required a second surgical
procedure and 13 required percutaneous drainage; a single surgical pro
cedure sufficed in 69%. Enteric fistulae occurred in 16% of patients.
The mean hospital stay after surgery was 41 days, and the interval unt
il return to regular activities was 147 days. A significant negative c
orrelation between duration of pancreatitis and outcome scores was fou
nd, and sequential group comparison demonstrated that the change point
at which significantly better outcomes were encountered was day 27, C
onclusion Debridement of pancreatic necrosis followed by closed packin
g and drainage is accomplished with a low mortality rate and reduced r
ates of complications and second surgical procedures. Although interve
ntion is best deferred until the demarcation of necrosis is complete,
delay beyond the fourth week confers no additional advantage.