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Journal of Hepato-Biliary-Pancreatic Sciences

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01-01-2013 | Guideline

TG13 surgical management of acute cholecystitis

Authors: Yuichi Yamashita, Tadahiro Takada, Steven M. Strasberg, Henry A. Pitt, Dirk J. Gouma, O. James Garden, Markus W. Büchler, Harumi Gomi, Christos Dervenis, John A. Windsor, Sun-Whe Kim, Eduardo de Santibanes, Robert Padbury, Xiao-Ping Chen, Angus C. W. Chan, Sheung-Tat Fan, Palepu Jagannath, Toshihiko Mayumi, Masahiro Yoshida, Fumihiko Miura, Toshio Tsuyuguchi, Takao Itoi, Avinash N. Supe

Published in: Journal of Hepato-Biliary-Pancreatic Sciences | Issue 1/2013

Abstract

Background

Laparoscopic cholecystectomy is now accepted as a surgical procedure for acute cholecystitis when it is performed by an expert surgeon. There are several lines of strong evidence, such as randomized controlled trials (RCTs) and meta-analyses, supporting the introduction of laparoscopic cholecystectomy for patients with acute cholecystitis. The updated Tokyo Guidelines 2013 (TG13) describe the surgical treatment for acute cholecystitis according to the grade of severity, the timing, and the procedure used for cholecystitis in a question-and-answer format using the evidence concerning surgical management of acute cholecystitis.

Methods and materials

Forty-eight publications were selected for a careful examination of their full texts, and the types of surgical management of acute cholecystitis were investigated using this evidence. The items concerning the surgical management of acute cholecystitis were the optimal surgical treatment for acute cholecystitis according to the grade of severity, optimal timing for the cholecystectomy, surgical procedure used for cholecystectomy, optimal timing of the conversion of cholecystectomy from laparoscopic to open surgery, and the complications of laparoscopic cholecystectomy.

Results

There were eight RCTs and four meta-analyses concerning the optimal timing of the cholecystectomy. Consequently, it was found that cholecystectomy is preferable early after admission. There were three RCTs and two meta-analyses concerning the surgical procedure, which concluded that laparoscopic cholecystectomy is preferable to open procedures. Literature concerning the surgical treatment according to the grade of severity could not be quoted, because there have been no publications on this topic. Therefore, the treatment was determined based on the general opinions of professionals.

Conclusion

Surgical management of acute cholecystitis in the updated TG13 is fundamentally the same as in the Tokyo Guidelines 2007 (TG07), and the concept of a critical view of safety and the existence of extreme vasculobiliary injury are added in the text to call the surgeon’s attention to the need to reduce the incidence of bile duct injury.

Free full-text articles and a mobile application of TG13 are available via http://www.jshbps.jp/en/guideline/tg13.html.

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Title: TG13 surgical management of acute cholecystitis
Authors: Yuichi Yamashita
Tadahiro Takada
Steven M. Strasberg
Henry A. Pitt
Dirk J. Gouma
O. James Garden
Markus W. Büchler
Harumi Gomi
Christos Dervenis
John A. Windsor
Sun-Whe Kim
Eduardo de Santibanes
Robert Padbury
Xiao-Ping Chen
Angus C. W. Chan
Sheung-Tat Fan
Palepu Jagannath
Toshihiko Mayumi
Masahiro Yoshida
Fumihiko Miura
Toshio Tsuyuguchi
Takao Itoi
Avinash N. Supe
Publication date: 01-01-2013
Publisher: Springer Japan
Published in: Journal of Hepato-Biliary-Pancreatic Sciences / Issue 1/2013
Print ISSN: 1868-6974
Electronic ISSN: 1868-6982
DOI: https://doi.org/10.1007/s00534-012-0567-x

At a glance: The STEP trials

Springer Medicine

TG13 surgical management of acute cholecystitis

Abstract

Background

Methods and materials

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods and materials

Results

Conclusion

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Newsletter, January 1, 2013