Objective: To investigate different treatment methods of SAP with massive peripancreatic fluid collections. Methods: The clinical data of 162 patients with SAP and concomitant massive peripancreatic fluid collections treated during October 2008 to May 2015 were retrospectively analyzed. Of the patients, 68 cases underwent conservative treatment (conservative treatment group), 67 cases underwent ultrasound or CT guided percutaneous puncture and catheter drainage (puncture drainage group), 13 cases underwent laparoscopic surgery (laparoscopic group) and 14 cases underwent traditional open surgery (laparotomy group). The relevant clinical variables among groups were compared. Results: The general data of the four groups were comparable. The times for disappearance of symptoms and for recovery of serum amylase in puncture drainage group and laparoscopic group were significantly shorter than those in conservative treatment group, and the times for most abdominal effusion absorption and bladder pressure decrease in conservative treatment group were significantly later than those in the other three groups (all P<0.05). In puncture drainage group or laparoscopic group, the length of hospital stay was significantly shorter and incidence of complications was significantly lower than those in conservative treatment group or laparotomy group (all P<0.05). The effective success rate was significantly lower and re-operation rate was significantly higher in conservative treatment group than those in the other three groups (all P<0.05). The mortality rates were significantly increased in conservative treatment group and laparotomy group compared with puncture drainage group or laparoscopic group (all P<0.05). Conclusion: Ultrasound or CT guided percutaneous puncture and catheter drainage or catheter drainage via laparoscopic retroperitoneal approach has demonstrable efficacy in treatment of SAP with massive peripancreatic fluid collections, with advantages of low incidence of complications and mortality rates.