Immediate necrosectomy for infected walled-off pancreatic necrosis offers no advantages over an on-demand approach.

• Clinical success rates were similar: 92% (immediate) vs. 88% (on-demand), p = .5.
• On-demand patients required fewer necrosectomy sessions (1 vs. 2, p ≤ .01) and had fewer adverse events (24% vs. 40%, p = .2).

This suggests that a selective on-demand strategy might lead to less intervention and better safety profiles in surgical management.

• 44% of the on-demand group resolved their condition without needing necrosectomy.