Surgical interventions are unshakable in the treatment of SAP Timely surgical interventions: still irreplaceable in the treatment of SAP Accurate determination of the timing of surgical drainage, surgical indications, and surgical approach Combined with early inflammatory regulation, organ function support, fluid therapy, and maintenance of the internal environment Timing of surgical interventions Avoiding surgical interventions within 2 weeks of onset It is generally considered that 4 weeks after onset is the best time for necrotic tissue removal, facilitating debridement and intraoperative bleeding The risk is small. 1. fulminant acute pancreatitis (FAP): early onset of MODS and ACS 2. biliary pancreatitis combined with biliary obstruction 3. definite peripancreatic infection with severe toxic symptoms 4. late intervention indications: necrotic lesions 6 cm in diameter with gastrointestinal compression 5. systemic reaction symptoms of aseptic necrosis and pancreatic pseudocysts, including peripancreatic abscesses 6. elective cholecystectomy Surgical intervention modalities 1. PCD: B-ultrasound or CT-guided percutaneous puncture for drainage tube placement, which is the most common, simple and safe modality 2. B. Peritoneal approach via the parietal ascending colon: for early SAP infection C. Posterior gastric wall approach: for late infection, pancreatic abscess and cyst formation D. Laparoscopic cholecystectomy is the best procedure for late SAP elective 4.1 Transoral gastroscopy: transgastroscopy is suitable for: drainage of pancreatic pseudocysts close to the posterior gastric wall, avoiding abdominal contamination and extra-pancreatic fistula formation, but there is a risk of bleeding and gastric perforation 4.2 transabdominal wall gastroscopy: 5. nephroscopy or choledochoscopy: percutaneous puncture under ultrasound or CT guidance, stepwise expansion of the puncture tunnel with a fascial dilator, drainage tube replaced with a larger caliber drainage tube, application of nephroscopy or choledochoscopy to enter the lesion through the dilated formed sinus tract, removal of necrotic tissue and drainage under direct vision. 6, open closed drainage route A, through the anterior abdomen, small omental sac B, posterior lumbar retroperitoneum Drainage route: high to low, front to back, top to bottom “kissing” flushing and drainage 7, open abdominal cavity: is the most direct and effective surgical way to solve FAP complicating ACS, but it will lead to abdominal and retroperitoneal infection Non-obstructive Biliary pancreatitis should be treated non-operatively, and cholecystectomy should be performed at an elective stage (after 3 months) after the pancreatitis is healed.