In recent years we are observing an increasing number of authors. The surgical results, in the elective cases, are improved drammatically, and now, in many Centers, the mortality rate is less than 5%. We haven't observed the same improvements for the emergency cases. In this setting the mortality rate is still around 50% or more. What we are facing, however, is the changing of the clinical picture of this patients. In the most part of cases, the patient dies in the Intensive Care Unit, after a long and complex post-operative course, and not more in the Operating Room. Still, this could be considered a good result, expression of a better surgical experience. The way to obtain higher survival, at the moment, is linked to a better understanding of the physiologic derangements in the Intensive Care Unit. The authors discuss the organizative and technical changes the permitted to achieve this results.