Timing, treatment strategies and approach for infected pancreatic necrosis:a narrative review

Infected pancreatic necrosis(IPN)is a serious complication resulting in organ failure and death in patients with acute pancreatitis,and surgery is an important way to treat this disease.An increasing number of high-quality studies have provided evidence for mini-invasive necrosectomy and have also changed the traditional treatment model.The advancements of surgical technology provide more choices for IPN treatment.Timing,strategies,and treatment approach are still the most critical issues,even in today’s era of minimally invasive surgery.Should“delayed surgery”or“postponed drainage”still be adhered to?The“step-up”approach has been proven to hold an advantage in the treatment of IPN in terms of reducing postoperative complications.However,there is growing evidence that"step-up"is not the only option for all patients.The one-step approach is also effective for selected patients.Currently,endoscopic surgery is increasingly widely used in the treatment of IPN.On the other hand,open debridement is still an position for patients who do not respond to minimally invasive surgery.How to personalize treatment strategies is still not fully clear.Multidisciplinary consulting treatment is bound to be the main direction of development for future studies.