Operative management of pseudocysts associated with chronic pancreatitis is effective with low morbidity and mortality rates. The introduction of newer minimally invasive techniques will have to withstand comparison to this traditional approach.

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We describe three cases of severe necrotizing pancreatitis, with Apache II scores of 11, 17 and 22, respectively. There was no significant pancreatic parenchymal perfusion in any of the three patients on contrast-enhanced computed tomography. All three patients were primarily treated with percutaneous drains and all three subsequently required open laparotomies. We do not recommend percutaneous drainage as a definitive therapy for severe necrotizing pancreatitis.

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The technique of laparoscopic fundoplication and its hospital management are described. Thirty day results in seven patients demonstrate the decreased insult to the patient, early discharge and early return to usual function, similar to that seen in laparoscopic cholecystectomy .