Objective: This study aimed to evaluate the surgical treatment of acute pancreatitis in Italy and to assesscompliance with international guidelines.Methods: A series of 1173 patients in 56 hospitals were prospectively enrolled and their data analysed.Results: Twenty-nine patients with severe pancreatitis underwent surgical intervention. Necrosectomywas performed in 26 patients, associated with postoperative lavage in 70% of cases. A feeding jejunostomywas added in 37% of cases. Mortality was 21%. Of the patients with mild pancreatitis, 714patients with a biliary aetiology were evaluated. Prophylactic treatment of relapses was carried out in 212patients (36%) by cholecystectomy and in 161 using a laparoscopic approach. Preoperative endoscopicretrograde cholangiopancreatography was associated with cholecystectomy in 83 patients (39%). Fortysevenpatients (22%) were treated at a second admission, with a median delay of 31 days from the onsetof pancreatitis. Eighteen patients with severe pancreatitis underwent cholecystectomy 37.9 days after thefirst admission. There were no deaths.Discussion: The results indicate poor compliance with published guidelines. In severe pancreatitis, earlysurgical intervention is frequently performed and enteral feeding is seldom used. Only a small number ofpatients with mild biliary pancreatitis undergo definitive treatment (i.e. cholecystectomy) within 4 weeksof the onset of pancreatitis.