Laparoscopic debridement and necrosectomy are described for the treatment for acute necrotizing pancreatitis. Three techniques are described: (1) retrogastric retrocolic debridement; (2) a full retroperitoneoscopic approach; and (3) a transgastric drainage. These three techniques were performed for necrotizing pancreatitis in a group of patients from 1993 to 1994. These techniques have resulted in 75% success of drainage and debridement of necrotizing pancreatitis. No mortalities were encountered during this time period, and reintervention was necessary in 25% of patients. Apart from a cosmetic advantage, less stress has resulted from the procedure, therefore promoting earlier recovery with potentially less fistula complications, which are often observed after open drainage.