Acute pancreatitis is a common emergency in the Department of Gastroenterology. The disease has a rapid onset and progresses rapidly, and in severe cases often requires multidisciplinary coordination including critical care, internal medicine and surgery. Generally speaking, acute pancreatitis includes both mild and severe cases, the former accounting for more than 80% of the total number of pancreatitis, for this part of patients, basically no surgical procedures, simple fasting and medical drug therapy can make the condition remission. For the other 20% of patients with severe pancreatitis, existing studies show that the timing of surgery needs to be carefully chosen. In the past, it was thought that acute pancreatitis was caused by the activation of pancreatic enzymes that caused the self-digestion of the pancreas, so it was necessary to remove the necrotic tissue as soon as possible to reduce the damage caused by pancreatic enzymes. However, with a number of evidence-based medical studies at home and abroad, the morbidity and mortality rates and complication rates of patients who underwent early surgery were significantly higher than those who took non-surgical treatment. Therefore, acute pancreatitis within 2 weeks is generally not suitable for surgical treatment, unless the patient develops early fulminant pancreatitis or complications of abdominal septal syndrome, the former manifesting as multi-organ failure that cannot be controlled by drugs within 72 hours of onset, and the latter manifesting as a marked increase in intra-abdominal pressure that requires emergency surgical decompression. So is surgery necessary for the late stage of acute pancreatitis? In fact, most patients undergo meticulous medical treatment and their condition is controlled, and if there are no complications, surgery can be avoided. For patients with local complications, if they are not accompanied by infection, such as pancreatic pseudocysts, they can also be treated endoscopically in internal medicine. For example, our department uses endoscopic drainage to treat pancreatic pseudocysts with good results: patients avoid painful surgery, shorten their hospital stay, and reduce the financial burden. As for patients with infectious complications such as pancreatic abscess formation, although there are international reports of successful endoscopic treatment, surgical removal of infected necrotic tissues is still basically the main focus in China. In general, the indications for surgery for acute pancreatitis are mainly limited to a few cases such as fulminant pancreatitis, pancreatitis combined with abdominal septal compartment syndrome, and pancreatitis combined with local infection. Minimizing surgery and minimally invasive surgery have become the current direction of development in the treatment of acute pancreatitis.