Acute pancreatitis remains one of the common causes for hospital admission in tertiary care center. Natural history of acute pancreatitis still remains the same. Around 20–30% of acute pancreatitis is severe acute pancreatitis, which requires prolonged ICU care and intervention. Early severe acute pancreatitis is characterized by systemic inflammatory response syndrome and multiorgan failure that necessitates intensive care therapy. This chapter covers the indications for intervention in pancreatic necrosis, timing of intervention, preoperative imaging, estimating the extent of disease, classification of techniques of necrosectomy, role of ERCP, and postoperative complications. As local complications can develop any time after the second week, serial monitoring of clinical, biochemical parameters as well as repeated imaging is needed to identify the local complication and select appropriate therapy.