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Table 5 Situations in which open necrosectomy is a valid option for treatment of infected pancreatic necrosis

From: Open necrosectomy in acute pancreatitis–obsolete or still useful?

Treatment failure or complication (e.g., persistent bleeding after attempted endovascular treatment) after step-up management procedure
Bowel ischemia or perforation (suspected/verified) due to necrosis
Ongoing open abdomen with simultaneous indication for necrosectomy
Disconnected left pancreatic remnant fueling the disease
Insufficient experience or equipment for mini-invasive necrosectomy
Biliary pancreatitis with simultaneous need for cholecystectomy
Anatomically widespread necrosis