The purpose of this study is to evaluate efficacy of the surgical indications in acute pancreatitis. During the period from May 2000 to June 2009, 107 operated patients with pancreatic necrosis were treated in the Severe Acute Pancreatitis Unit of the HNERM a comparison was made by separating the patients in two groups according to the surgical indication. An analysis was carried out in order to evaluate which type of surgical indication has the best results according to age, severity of the case, return to oral intake, hospital stay, complications and mortality. On evaluating the indication by positive puncture for detecting necrosis infection we found that 89% of the patients operated due to this indication showed infected necrosis while those operated due to the indication of "sepsis without response to the ICU treatment" only reached 51%. Surgical complications and re operations, was higher among the patients whose indication was "sepsis without response to the ICU treatment" (Indication B) in comparison with positive FNA. (Indication A) CONCLUSION: Positive fine needle aspiration is the surgical indication par excellence in acute pancreatitis with necrosis. We consider that the indication of "sepsis that do not respond for more than 72 hours to treatment in the ICU regardless that negative FNA" should not be taken into account, due to the very high percentage of sterile necrosis found at the time of surgery.