The majority of severe pancreatitis does not require surgery, and some patients require surgery when complications exist. Severe pancreatitis is a special type of acute pancreatitis, the condition is dangerous, many complications, high mortality rate, do not actively advocate surgical treatment; the emergence of serious local complications such as infection, local necrosis of endocardial fistula, bile duct obstruction and other conditions need to consider surgery, surgery should try to avoid subsequent complications or sequelae. The cases of severe pancreatitis requiring surgery are as follows. 1. peripancreatic combined with severe infection, which can not be controlled by drugs, local bleeding, perforation, etc., need timely surgical debridement intervention. 2. Localized formation of encapsulated necrosis, internal fistula, pancreatic pseudocyst or abscess formation and compression of the surrounding organs, the need for adequate surgical drainage. 3. If complicated with obstruction of common bile duct, surgery is needed to relieve obstruction or incision and decompression drainage. To summarize, in the course of treatment of severe pancreatitis, adequate examination and observation are required, and changes in the condition need to be dealt with in a timely manner, and whether or not to operate should be judged by the physician according to the condition.