In Denmark, based on weak evidence from 2002, a surgical window of maximum four days after debut of symptoms has up till now been recommended. Based on 12 randomised controlled studies (RCTs) we conclude, that the surgical window may be extended to seven days. The main advantage is a significant reduction of total hospital stay and apparently without compromising safety. Unfortunately, evidence is based on mostly statistically underpowered RCTs of low or moderate methodological quality, and final conclusions on surgical results are still not possible.