Background and Aims: At present, the concept of surgical treatment of severe acute pancreatitis (SAP) combined with infectious pancreatic necrosis (IPN) has gone through a transition from the previous early open surgery to the delayed surgery with minimally invasive, step-up approach and adequate drainage. According to this new concept, this study was conducted to compare the clinical efficacy of two minimally invasive surgical methods in treatment of SAP with IPN. 
Methods: The clinical data of 53 patients with SAP who developed IPN treated from January 2014 to May 2019 were retrospectively analyzed. Of the patients, 26 cases underwent percutaneous nephroscopic necrosectomy via retroperitoneal approach (percutaneous nephroscopic group) and 27 cases underwent laparoscopic necrosectomy (laparoscopic group). The preoperative general data, main efficacy variables and the changes in infection indexes before and after surgery were compared between the two groups of patients. 
Results: There were no significant differences in the general data between the two groups of patients (all P>0.05). Operations were uneventfully completed in all patients, 2 cases in percutaneous nephroscopic group underwent second sinus tract exploration and debridement 2 weeks later under bedside local anesthesia, and 2 cases in laparoscopic group were converted to open surgery. Comparison between percutaneous nephroscopic group and laparoscopic group showed that the average operative time (51.8 min vs. 57.4 min), average intraoperative blood loss (50.2 mL vs. 65.8 mL), average time to postoperative gas passage (21.6 h vs. 22.7 h), average length of postoperative hospital stay (48.5 d vs. 51.2 d), and average hospital cost (82 000 yuan vs. 106 000 yuan) were significantly decreased in the former (all P<0.05). The postoperative drainage volume of patients in both groups were increased compared with those before surgery, and the infection indexes that included the body temperature, white blood cell count, procalcitonin, C-reactive protein, interleukin-6, and score of CT severity index (CTSI) for pancreatitis were all decreased after surgery compared with those before surgery (partial P<0.05), but there were no differences in all above variables between the two groups at the same time point (all P>0.05). The incidence of total postoperative complications such as intestinal fistula, pancreatic fistula, bleeding, pneumonia and pancreatic pseudocyst showed no significant difference between percutaneous nephroscopic group and laparoscopic group (34.6% vs. 37%, P>0.05).
Conclusion: The symptoms of infection and intoxication in patients with SAP and concomitant IPN can be significantly improved by the two treatment methods, and they both have demonstrable efficacy. Compared with laparoscopic surgery, percutaneous nephroscopic procedure has advantages in terms of operative time, blood loss, postoperative recovery and hospitalization cost, without increasing the incidence of complications. So, it is recommended to be used in clinical practice.