Abstract: The development of treatment of severe acute pancreatitis (SAP) has gone through a dramatic transformation from radical surgery to conservative treatment, and now to a multidisciplinary comprehensive diagnosis and treatment model which combines minimally invasive and open surgery. Due to the complexity, rapid progression, and significantly individual differences, some patients of SAP may experience surgical emergencies such as gastrointestinal fistula, severe abdominal infection, massive bleeding, abdominal compartment syndrome, and severe biliary system complications. Conservative treatment has little effect and often requires decisive surgical rescue to potentially save the patients′ lives. Based on clinical practice and the latest literature, the authors introduce the concept of surgical rescue into the treatment of SAP for the first time, in order to explain the strategies of surgical rescue in the SAP disease process and the key points of implemen-ting surgical rescue in different situations, and to provide personal insights on how to improve the success rate of surgical rescue for further improving the overall cure rate of SAP.