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Background:The initial treatment of Severe Acute Pancreatitis(SAP)is conservative.The standard management was operative intervention in patients with(suspected) infected necrotizing pancreatitis.Mode of intervention depends on various factors.The aim of the present study was to evaluate the effectiveness of non-operative management in patients with SAP.Methods:Ongoing prospective study carried out from April 2008 onwards.All consecutive patients (64) with SAP were recruited in the study.Patients were initially managed conservatively and as per the indication underwent intervention.The outcome in patients managed with different modalities was compared.Results:Of the 64 consecutive patients with SAP, 41 patients were managed non-operatively.Out of which 14 patients were managed conservatively, 27 patients underwent PCD alone and the remaining 23 patients underwent initial PCD followed by surgery.There was one mortality in patients managed conservatively and three mortalities in those managed by PCD alone.Mortality was 11/23 (47.8%) in patients requiring surgery.Overall mortality in the whole group was 15/64 (23.4%).Significant factors leading to failure of non operative management in this series are renal failure (p- 0.002),coagulopathy (p-0.001), APACHE>9 (p-0.003), persistent respiratory failure (p-0.000) , ICU admission > 5 days (p-0.000), and infected necrosis (p-0.000). Conclusions:Overall mortality in this group of SAP was 23.4%.Patients with non-operative management had 9.7% mortality.Surgery was required in 35.9% patients in this series.Mortality in patients with surgical management was 47.8%,of which the disease specific mortality was 39.1%.