The aim of this work was to estimate the efficiency of the proposed surgical treatment for acute necrotizing pancreatitis. Materials and Methods: We analyzed the outcomes of the treatment of 317 patients with acute necrotizing pancreatitis in whom the proposed surgical treatment was used over the period of 2013–2019. The new postoperative onset of organ failure, duration of intensive care treatment, postoperative complications, and mortality rates was studied. Results and Discussion: We used the step-up approach to surgical treatment, which started from either diapeutic transcutaneous ultrasound-guided procedures in 48.2 % and endoscopic ultrasound-guided – in 46.2 % of cases. Transcutaneous procedures were followed by less complication rate in acute necrotic collection cases whereas endoscopic operations – in walled-off pancreatic necrosis patients. Wide laparotomic necrosectomies were applied in 14.5 % of patients after the 4th week of the disease onset. The overall mortality rate was 3.5 %, and after the surgical treatment – 6.5 %. Application of step-up surgical treatment in patients with ANP decreases the need to perform wide laparotomic necrosectomies and reduces the rate of postoperative complications.