The aim of this study is a current review of multidisciplinary therapeutic concepts in severe acute pancreatitis, the following being envisaged in succession: --severity criteria and factors involved in surveillance, --medical methods of intensive therapy, --surgical treatment in terms of its indications and tactical implications. Remaining in overall control, the surgeon must pay careful attention to the techniques used, and results achieved, by the intensive care specialist. In the presence of concomitant lithiasis of the common bile duct, it is essential to request endoscopic sphincterotomy first. The surgeon must interpret with the radiologist CT scan films in order to be able to wait, whilst remaining alert at all times, for the appropriate moment for any possible surgery. The surgeon must above all avoid being too active too early.