Purpose. To develop optimal surgical tactics in patients with sterile necrotizing pancreatitis, based on the experience of the acute sterile pancreatitis treatment in the clinic. Material and methods. The necrotizing pancreatitis was diagnosed in 504 out of 1751 (28.8%) patients treated for acute pancreatitis in the last 5 years in our clinic. The necrotizing pancreatitis was diagnosed by clinical, laboratory and instrumental (ultrasound, computed tomography, laparoscopy) methods; 217 patients (12.4%) have been operated. Results. All patients with severe pancreatitis were hospitalized in the resuscitation and intensive therapy department, where monitoring of vital parameters, implemented systematic conservative treatment. If the treatment was not effective, the next step would be the indications for the early (during the first 3—5 days) surgical treatment. Among 217 operated patients 125 (57.7%) have got laparoscopic surgery. The successful treatment was in 77 patients (61.6%), who succeeded in condition stabilization. In 48 patients (38.4%) after laparoscopic sanitation of the abdominal cavity and drainage, despite therapy, inflammation of the pancreas progressed, and they had to be operated through open laparotomy operation. Our surgical tactics of necrotizing forms of acute pancreatitis treatment has significantly reduced the incidence of postoperative complications (down to 49.8%) and mortality (down to 28.5%). Conclusion. The results of the study show that the majority of patients with sterile form of necrotizing pancreatitis need early minimally traumatic interventions. It should also be noted that severe forms of acute pancreatitis require multidisciplinary treatment strategy that should be suited personally for each patient.