ABSTRACT
The treatment of the severe acute pancreatitis has changed too fast in the last years and the new tendencies and continuous updates are forcing us to constantly vary the disease management protocols taking into account that what is true for today may prove to be a mistake tomorrow.In the Severe Acute Pancreatitis Unit of Eduardo Rebagliati Martins Hospital we believe there are four paradigms that can change the way we treat the disease.In the Unit we believe that a prophylactic antibiotic therapy is not effective in diminishing the incidence of infected necrosis nor in decreasing the death rate among patients with acute pancreatitis with necrosis, since the works published in the last two years make evident the clear tendency to the inefficiency of this therapy.In the protocol of the Unit there is no indication for surgical intervention of sterile necrosis since the surgical treatment could become the factor increasing the severity of the case that would cause higher death rates among patients with sterile pancreatic necrosis.The only and true absolute indication for surgery is a positive fine needle punction which discards "sepsis in the absence of an extrapancreatic source of infection" as surgical indication and allows the presence of gas in the tomography to be a relative indication for surgical intervention. In the Unit we consider that a pancreatic necrosectomy can be performed in one surgery as long as this can be delayed as much as possible.