Objective: To investigate the clinical efficacy of minimally invasive procedures in treatment of infected pancreatic necrosis (IPN) complicated with duodenal fistula (DF).  
Methods: The clinical data of 155 consecutive patients with IPN treated in the Department of Biliopancreatic Surgery of Xiangya Hospital, Central South University from January 2015 to May 2019 were retrospectively analyzed, with emphasis on the clinical characteristics, minimally invasive surgical methods and clinical outcomes of the cases with DF among them.
Results: Among the 155 patients with IPN, 15 cases (9.7%) were complicated with DF. Of the 15 patients with concomitant DF, the median time span from onset to occurrence of DF was 2.9 (1–12) months; 2 cases underwent percutaneous catheter drainage (PCD) only, and 13 case underwent PCD plus minimal access retroperitoneal pancreatic necrosectomy (MARPN); 2 cases who underwent PCD plus MARPN died from uncontrollable sepsis and massive hemorrhage; the fistula spontaneously healed in the 13 cases after minimally invasive treatment and enteral nutrition support, with the median duration of the fistula of 1.5 (0.5–3) months; open surgical treatment was not required in any of them. The median follow-up of the 13 patients was 18 (2–36) months, 
all of them were alive and no infection or DF recurrence was noted. In IPN patients with DF compared with the 140 cases without DF, the length of total hospital stay was significantly prolonged (P<0.01), but the mortality and other clinical variables showed no significant differences (all P>0.05).
Conclusion: In qualified acute pancreatitis treatment center, minimally invasive surgery combined with effective enteral nutrition support is an effective method of treatment for IPN complicated with DF.