The treatments of severe acute pancreatitis have always been hot issues domestic and abroad. Throughout the history of the diagnosis and treatment of SAP, the concepts of treatments reflect their own historiography. The surgical procedures for SAP have greatly changed with the advanced idea of minimally invasive surgery, especially in the treatment of infectious pancreatic necrosis in late stage. Opening debridement and drainage has been gradually replaced by the minimally invasive techniques, such as percutaneous catheter drainage, endoscopic, laparoscopic and step-up approach strategies. The newly concepts are becoming more pluralistic in variety of minimally invasive methods. Therefore, this is the basic principle and inevitable trend for the therapies of SAP through advocating the concepts of minimally invasive surgery in the twenty-first century.