Twenty-eight patients underwent open pancreatic necrosectomy in a tertiary referral Hepatobiliary unit over the last decade. Median logistic organ dysfunction score on admission to critical care was 3 (0–10). Median LODS after surgery was 2 (0–8). Overall episode-related mortality was 22% (6 deaths). Modern open necrosectomy can be performed without procedure-related deterioration in organ dysfunction.