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BACKGROUND: The present study reports the long term functional and morphological changes following severe acute pancreatitis and compares the patients managed by operative and non-operative methods.METHODS: 30 patients who had completed one year of follow up after recovery from attack of acute pancreatitis were evaluated. 72 hours fecalfat analysis, glucose tolerance test and pancreatic morphology (MRI) were examined and recurrences if any were noted.RESULTS:Etiology was alcohol (15) , gall stones (10) ,and idiopathic (5) . Twelve patients were managed non-operatively, out of which five patients needed pigtail drainage . 18 patients required open necrosectomy. Mean follow up was 28.2 months. 16 patients (62%) had readmissions . 11 patients (36.7%) had exocrine deficiency and 14 patients (46.7%) had endocrine deficiency , 7 patients had both. 82.8% patients had morphological changes in pancreas. Patients undergoing necrosectomy had higher incidence of endocrine dysfunction (61.1% of patients in surgical group and 25% in non-operative group (p= 0.057).Exocrine abnormality was also significantly higher in surgical group compare to non-operative group(55.6% versus 8.3%, p= 0.010). Morphological changes in pancreas were also higher in operated group but was not statistically significant.CONCLUSION: Patients of severe acute pancreatitis on follow up had significant functional, and morphological changes with 62% patients requiring readmission. Patients who were managed non-operatively had lesser incidence of exocrine and endocrine deficiencies, though there was no significant difference in pancreatic morphological changes .