Acute pancreatitis is more of a range of diseases than it is a single pathologic entity. Its clinical manifestations range from mild, perhaps even subclinical, symptoms to a life-threatening or life-ending process. The classification of acute pancreatitis and its forms are discussed in fuller detail by Sarr and colleagues elsewhere in this issue. For the purposes of this discussion, the focus is on the operative interventions for acute pancreatitis and its attendant disorders. The most important thing to consider when contemplating operative management for acute pancreatitis is that we do not operate as much for the acute inflammatory process as for the complications that may arise from inflammation of the pancreas. In brieSurgical treatment of acute pancreatitisf, the complications are related to: necrosis of the parenchyma, infection of the pancreas or surrounding tissue, failure of pancreatic juice to safely find its way to the lumen of the alimentary tract, erosion into vascular or other structures, and a persistent systemic inflammatory state. The operations may be divided into three major categories: those designed to ameliorate the emergent problems associated with the ongoing inflammatory state, those designed to ameliorate chronic sequelae of an inflammatory event, and those designed to prevent a subsequent episode of acute pancreatitis. This article provides a review of the above.