The issue of the treatment of acute destructive pancreatitis continues to be extremely relevant. In Moscow in the structure of acute surgical diseases acute pancreatitis took the first place in 2013 for the first time. At the same time, growth trend of destructive forms of this disease accompanied by a large number of complications and high mortality persists. The study is based on the results of surgical treatment of 73 patients with developed purulo-necrotic complications of destructive pancreatitis treated in State Clinical Hospital №68. Patients were divided into two groups according to the method of surgical treatment. Main (1st) group consisted of 32 (44%) patients in whom combination of percutaneous and endovideosurgical interventions was applied. In the 2nd group (control group) 41 (56%) patients were treated with minimally invasive procedures under ultrasound guidance. Study revealed that in the treatment of patients with purulo-necrotic complications of destructive pancreatitis minimally invasive interventions under ultrasound and X-ray guidance is always possible to perform at the first step. However, in terms of persistent inflammatory syndrome within postoperative 20 days adequate sanation of suppurative foci are necessary. Endovideosurgical access in order to provide minimal surgical trauma is preferable. In such a case surgery will proceed under more favorable conditions as far as by that time demarcation of necrosis will take place. Therefore, application of combined minimally invasive and endovideoscopic techniques enabled to decrease mortality and to reduce length of hospital stay.