Objective: To evaluate the efficacy of surgical intervention in the treatment of severe acute pancreatitis (SAP). Methods: The clinical data and results of 36 SAP patients undergoing surgical treatment from June 2009 to August 2012 were retrospectively analyzed. Results: Among the 36 SAP patients, 11 cases (30.5%) were caused by biliary factors, 2 cases (5.6%) were associated with pregnancy, 20 cases (55.6%) were due to alcohol abuse or overeating, and 3 cases were induced by other causes. Nine patients (25.0%) received early operation, of whom, 7 cases underwent cholecystectomy, choledocholithotomy, T-tube drainage, and peritoneal lavage, while 2 cases underwent exploratory laparotomy and irrigation/drainage of the pancreatic bed. Twenty-seven patients received delayed operation; all of them underwent pancreatic necrosectomy and peritoneal lavage, and in 4 cases cholecystectomy, choledocholithotomy and T-tube drainage were simultaneously performed. Two patients died of multiple organ dysfunction syndrome (MODS) and sepsis, 3 patients refused continued hospitalization and were lost to follow-up because of noncompliance, and all other patients were discharged after full recovery. Conclusion: Surgery is an important component in the treatment of SAP; appropriate timing and surgical treatment methods can reduce complications, improve therapeutic efficacy, and save the lives of critically ill patients.