Infected pancreatic necrosis is a severe complication of acute pancreatitis, requiring timely and appropriate intervention. While percutaneous catheter drainage has been widely used, it often fails to remove solid necrotic debris completely. Video-assisted retroperitoneal debridement has emerged as a minimally invasive alternative, allowing for direct debridement and better outcomes in selected patients.

Initial management of necrotizing pancreatitis is conservative, with intervention reserved for infected necrosis and clinical deterioration. Open necrosectomy, although effective, carries significant risks, including high mortality, incisional hernia, and fistula formation. Recent guidelines and trials, such as the PANTER study, have favored a step-up approach—starting with PCD and escalating to VARD if needed—due to lower morbidity and equivalent long-term outcomes.

VARD has shown efficacy, especially in deep-seated or complex collections. Studies report overall mortality around 13percent, with complications such as pancreatic fistula, bleeding, enteric fistula, and organ perforation. On average, one to three VARD procedures may be required. Approximately 61 percent of patients can be successfully treated with VARD alone.

Comparative studies, including the POINTER and TENSION trials, indicate that delayed and minimally invasive interventions are generally favorable over early or open approaches. However, VARD’s role is still evolving, and optimal patient selection remains crucial. While endoscopic techniques may offer advantages in some settings, VARD continues to play a key role in cases where PCD alone is inadequate.

This trial aims to assess the safety and efficacy of VARD compared to radiological percutaneous interventions, hypothesizing that VARD offers improved clinical outcomes in appropriate patient populations.