Severely acute necrotizing pancreatitis (degrees II and III) requires good teamwork between surgery and intensive care from the very beginning. Treatment was successful in 10 of 12 of our cases (83.4%); laparotomy and subsequent endoscopic necrosectomy were performed using a mediastinoscope, supplemented by optimal perioperative intensive therapy (long-term respiration with PEEP, infusion therapy, calcitonin, antibiotics, etc.). Before 1981, lethality amounted to 70%. No relaparotomies were necessary and organ failures (kidney and lung) were avoided.