Introduction. With the unsuccessfulness of an intensive therapy and minimally invasive interventions in severe acute pancreatitis they resort to the «open» surgical interventions. It is important to know about the classification of complications of such surgeries, the frequency of occurrences, the recognition peculiarities and the determination of a treatment plan for the practical surgery. Aim. The optimization of the usage of «open» surgeries for patients with severe acute pancreatitis. Material and methods. An «open» surgery has been performed on 322 patients for 25 years, 102 (31.6%) of them had different complications, 35 (34%) of them died. The intraoperative, early and «seamed» complications have been allocated. The rational treatment concepts of the complications of «open» surgeries, which are special for their diversity and paired with tactical and technical difficulties, have been developed. Conclusion. The main reasons for the development of complications of «open» surgeries for severe acute pancreatitis are the destruction of the wall of the main pancreatic duct, parapancreatitis, the intervention of a hollow organ or a vessel of trunk in a purulent lesion. As a rule, mentioned changes appear due to the long-team course of severe acute pancreatitis.