This study, published in the *New England Journal of Medicine*, compared the outcomes of two treatment approaches for necrotizing pancreatitis with infected necrotic tissue: primary open necrosectomy and a minimally invasive step-up approach. The step-up approach involves percutaneous drainage followed by minimally invasive retroperitoneal necrosectomy if necessary. The primary endpoint was a composite of major complications or death. The results showed that the step-up approach significantly reduced the rate of major complications or death compared to primary open necrosectomy (risk ratio 0.57, 95% CI 0.38 to 0.87, P=0.006). Additionally, the step-up approach led to fewer new-onset multiple organ failure, incisional hernias, and new-onset diabetes. The study concluded that the minimally invasive step-up approach is a more effective and less invasive treatment for necrotizing pancreatitis with infected necrotic tissue, reducing complications, long-term complications, healthcare resource utilization, and costs.This study, published in the *New England Journal of Medicine*, compared the outcomes of two treatment approaches for necrotizing pancreatitis with infected necrotic tissue: primary open necrosectomy and a minimally invasive step-up approach. The step-up approach involves percutaneous drainage followed by minimally invasive retroperitoneal necrosectomy if necessary. The primary endpoint was a composite of major complications or death. The results showed that the step-up approach significantly reduced the rate of major complications or death compared to primary open necrosectomy (risk ratio 0.57, 95% CI 0.38 to 0.87, P=0.006). Additionally, the step-up approach led to fewer new-onset multiple organ failure, incisional hernias, and new-onset diabetes. The study concluded that the minimally invasive step-up approach is a more effective and less invasive treatment for necrotizing pancreatitis with infected necrotic tissue, reducing complications, long-term complications, healthcare resource utilization, and costs.