Consensus advocating a principle of early organ support, nutritional optimisation, followed ideally by delayed minimally invasive\nintervention within a ââ?¬Å?step-upââ?¬Â framework where possible has radically changed the surgical approach to complications of\nacute pancreatitis in the last 20 years. The 2012 revision of the Atlanta Classification incorporates these changes, and provides\na background which underpins the complexities of individual patient management decisions. This paper discusses the place\nfor delayed minimally invasive surgical intervention (percutaneous necrosectomy, video-assisted retroperitoneal debridement\n(VARD)), and the rationale for opting to adopt a percutaneous approach over endoscopic or laparoscopic approaches in different\nclinical situations.
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