- Aim of drainage is to remove infected material without breaching the peritoneum
- Optimum method remains controversial – usually dependent upon local resources and expertise:
Percutaneous Drainage
- Associated with fewer complications than surgical necrosectomy though no mortality benefit
- Avoids surgical necrosectomy in 30-50% of cases
- Can be considered as a bridge to surgery in patients to unstable placement of a drainage tube into the fluid collection
Endoscopic Transluminal Drainage
- Like percutaneous drainage associated with less morbidity and cost than surgical necrosectomy
- Involves insertion of a stent to drain necrotic cavity into gastric or duodenal lumen
- Used only in carefully selected patients and is dependent on local expertise.
Surgical Necrosectomy
- Once the gold standard now less frequently used as first line
- Debridement is done bluntly with hydrosonic irrigation frequently used to avoid vascular injury
- May require multiple operations to achieve adequate debridement