When is faster better? Operative timing in acute care surgery.

PURPOSE OF REVIEW: Evaluation and treatment of the acute abdomen is the expertise of the general surgeon. Still, early and accurate diagnosis of this condition remains a dilemma and is particularly challenging in critically ill patients. This review examines recent literature regarding optimal timing of operation for common acute gastrointestinal conditions.

RECENT FINDINGS: No conclusive evidence exists to guide surgeons in the decision of when to operate on common gastrointestinal problems. Recent data support changes in traditional views of treating these conditions: the debate surrounding emergent appendectomy for acute appendicitis is more active than ever, but interval appendectomy appears to be unnecessary in asymptomatic patients, laparoscopic cholecystectomy for acute cholecystitis is safe, regardless of the duration of symptoms; sigmoid colectomy for acute diverticulitis is no longer required after two episodes; and surgeon experience with developing diagnostic and therapeutic technologies continues to evolve.

SUMMARY: A combination of physical findings, laboratory data, and directed imaging studies help establish a diagnosis and predict the benefit of surgical intervention in common acute abdominal problems. Advanced imaging technology and critical care support have facilitated changes in operative timing in acute care surgery.