The widely variable nature of acute pancreatitis renders it a challenging disease to manage via standardized approaches. King and Siriwardena present their findings from a survey of European surgical approaches to diagnostic and therapeutic management of severe acute pancreatitis in an attempt to delineate areas of discordance that may help direct future studies. An erratic trend in the management of severe acute pancreatitis is evident despite growing evidence to support several diagnostic and therapeutic procedures as standards of care. On the other hand, areas of discordance largely characterize those currently lacking in adequate literature support underscoring the need to generate randomized studies that will address them.