Retroperitoneal versus open intraperitoneal necrosectomy in step-up therapy for infected necrotizing pancreatitis: A meta-analysis

•Step-up therapy is the recommended therapy for infected necrotizing pancreatitis (INP).•However, the most appropriate secondary therapy for use after initial drainage has not been fully determined.•We searched for studies comparing retroperitoneal and open intraperitoneal step-up approaches for treating INP.•A total of 21 controlled studies and 2177 patients were included.•For treating INP, the retroperitoneal approach is safer and more effective than the open intraperitoneal approach.