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Surgical Endoscopy
Erschienen in:

26.01.2017

The optimal treatment of patients with mild and moderate acute cholecystitis: time for a revision of the Tokyo Guidelines

verfasst von: Charlotte S. Loozen, Maaike M. Blessing, Bert van Ramshorst, Hjalmar C. van Santvoort, Djamila Boerma

Erschienen in: Surgical Endoscopy | Ausgabe 10/2017

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Abstract

Introduction

According to the Tokyo Guidelines, severity of acute cholecystitis is divided into three grades based on the degree of inflammation and the presence of organ dysfunction. These guidelines recommend grade I (mild) acute cholecystitis to be treated with early laparoscopic cholecystectomy and grade II (moderate) acute cholecystitis with delayed cholecystectomy. Yet, several studies have shown that, for acute cholecystitis in general, early cholecystectomy is superior to delayed cholecystectomy in terms of complication rate, duration of hospital stay and costs. The aim of this study was to determine the clinical outcomes of emergency cholecystectomy in patients with grade II acute cholecystitis. Based on our findings, we propose a revision of the Tokyo Guidelines.

Methods

We performed a retrospective observational cohort study of 589 consecutive patients undergoing emergency cholecystectomy for acute calculous cholecystitis in a large teaching hospital between January 2002 and January 2015. Patients were classified according to the severity assessment criteria of the Tokyo Guidelines. Patients with grade I and grade II acute cholecystitis were compared for perioperative outcomes.

Results

Emergency cholecystectomy was performed in 270 patients with grade I acute cholecystitis and 187 patients with grade II acute cholecystitis. There was no difference in conversion rate (6 vs. 6%, p = 0.985) and operating time (60 min [25–255] vs. 70 min [30–255], p = 0.421). Also the perioperative complication rate (7 vs. 9%, p = 0.517), 30-day mortality (1 vs. 1%, p = 0.648) and length of hospital stay (4 days [1–42] vs. 4 days [1–62], p = 0.327) were similar between grade I and grade II acute cholecystitis.

Conclusion

The clinical outcomes of emergency cholecystectomy did not differ between patients with grade I and grade II acute cholecystitis. The findings support a revision of the Tokyo Guidelines with respect to the recommendation of performing emergency cholecystectomy in both grade I and grade II acute cholecystitis.
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Metadaten
Titel
The optimal treatment of patients with mild and moderate acute cholecystitis: time for a revision of the Tokyo Guidelines
verfasst von
Charlotte S. Loozen
Maaike M. Blessing
Bert van Ramshorst
Hjalmar C. van Santvoort
Djamila Boerma
Publikationsdatum
26.01.2017
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 10/2017
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-016-5412-x

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