The technique of open packing for patients with infected pancreatic necrosis has undergone considerable evolution since 1976 when we first used planned reoperation for this condition. Indications for this operative approach have become more clear and those details necessary for technical success have been refined; extensive initial exposure, thorough blunt debridement, nontraumatic packing, careful re-exploration, and secondary closure. Based upon the operative expression of these principles, in a clinically coherent longitudinal study of open packing in 96 consecutive patients with infected pancreatic necrosis over 20 years, we have been able to achieve an overall surgical mortality rate of 14.5%.