This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

A step-up approach or open necrosectomy for necrotising pancreatitis. N Engl J Med 2010; 362: 1491-1502.

Published: 2nd September 2010

Authors: Van Santvoort HC, Besselink MG, Bakker OJ, Hofker HS, Boermeester MA, Dejong CH et al. et al.

Conclusion

Thirty-five per cent of those randomized to the no initial surgery group were treated by percutaneous drainage alone, in this trial that included 88 patients. The step-up group had fewer complications including death (risk ratio 0.57, 95 per cent confidence interval 0.38 to 0.87, P=0.006), and lower rates of subsequent diabetes and incisional hernia.

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