Severe acute pancreatitis (SAP) has a mortality rate of up to 30%, and its incidence continues to rise each year, posing a significant economic and social burden. Nearly half of SAP patients may develop local complications such as infected pancreatic necrosis in the later stages of the disease, with treatment focused on controlling infection and its associated complications. With the development of minimally invasive treatment techniques, the "step-up" treatment strategy centered on minimally invasive techniques has improved patient outcomes. Surgical intervention plays a critical role in this treatment process, primarily by accurately determining the indications, timing, and methods for surgical intervention. This article discusses surgical intervention strategies for SAP, aiming to optimize the holistic treatment of SAP patients further.