BACKGROUND: Severe acute pancreatitis is a subtype of acute pancreatitis, associated with multiple organ failure and systemic inflammatory response syndrome. In this qualitative review we looked at the principles of pathogenesis, classifica-tion and surgical management of severe acute pancreatitis. We also looked at the current shift in paradigm in the manage-ment of severe acute pancreatitis since the guideline developed by the British Society of Gastroenterology.DATA SOURCES: Studies published between 1st January 1991 and 31st December 2015 were identified with PubMed, MED-LINE, EMBASE and Google Scholar online search engines us-ing the following Medical Subject Headings: "acute pancreati-tis, necrosis, mortality, pathogenesis, incidence"and the terms"open necrosectomy and minimally invasive necrosectomy". The National Institute of Clinical Excellence (NICE) Guide-lines were also included in our study. Inclusion criteria for our clinical review included established guidelines, randomized controlled trials and non-randomized controlled trials with a follow-up duration of more than 6 weeks.RESULTS: The incidence of severe acute pancreatitis within the UK is significantly rising and pathogenetic theories are still controversial. In developed countries, the most common cause is biliary calculi. The British Society of Gastroenterology, acknowledges the Revised Atlanta criteria for prediction of se-verity. A newer Determinant-based system has been developed. The principle of surgical management of acute necrotizing pancreatitis requires intensive care management, identifying infection and if indicated, debridement of any infected ne-crotic area. The current procedures opted for include standard surgical open necrosectomy, endoscopic necrosectomy and minimally invasive necrosectomy. The current paradigm is shifting towards a step-up approach.CONCLUSIONS: Severe acute pancreatitis is still a subject of grey areas in its surgical management even though new stud-ies have been recorded since the origin of the latest UK guide-lines for management of severe acute pancreatitis.
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