All fluid collections (defined by CT images) must be opened and evacuated by suction.
Removal of necrotic pancreatic and peripancreatic fatty tissue accomplished by blunt digital dissection or careful use of instruments and irrigation is the goal; sharp dissection is specifically avoided specifically to prevent uncontrollable hemorrhage.
Necrotic tissue is systematically sought in the retroperitoneum behind the transverse, ascending, and descending colon, and down to Gerota's fascia; all areas of necrosis are removed by blunt dissection.
Necrotic tissue and fluid from the operation room are sent for culture.
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