Abstract: Severe acute pancreatitis (SAP) is an ancient and fatal disease, the understanding of this disease has experienced tortuous and long-time process. Throughout the history, surgical intervention plays a dominant role in treatment of SAP. Instead of traditional “archaeological style-like” extensive resection, the strategy of minimally invasive debridement and drainage that was called “grave digging” is preferred currently. In the past two decades, with in-depth cognition about this disease, a series of interventional, minimally invasive & endoscopic techniques derived from computer-assisted imaging techniques, surgical strategy represented by “step-up” minimally invasive methods have been developed, which has changed traditional treatment model, brought satisfied therapeutic effect, and been widely accepted. Authors reviewed the process of surgical treatment in SAP for seeking deep understanding, gaining experiences, expanding our horizons, to guide clinical practices and avoid insufficient or excessive intervention, aiming to reduce mortality & morbidity and bring the maximal benefits for patients.