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01-05-2016 | Original Article

Could the Tokyo guidelines on the management of acute cholecystitis be adopted in developing countries? Experience of one center

Authors: Mahdi Bouassida, Hédi Charrada, Bilel Feidi, Mohamed Fadhel Chtourou, Sélim Sassi, Mohamed Mongi Mighri, Fethi Chebbi, Hassen Touinsi

Published in: Surgery Today | Issue 5/2016

Abstract

Purpose

The Tokyo guidelines for diagnostic criteria and severity assessment of acute cholecystitis (AC), published in 2007, recommend early laparoscopic cholecystectomy (ELC) be done as soon as possible after the onset of symptoms. We conducted this study to analyze the changes in the therapeutic strategy for AC in a surgical center in Tunisia after the Tokyo guidelines were published.

Methods

Between January, 2005 and January, 2013, 649 patients underwent cholecystectomy for AC at the Department of Surgery, Mohamed Tahar Maamouri Hospital in Nabeul, Tunisia. The study period was subdivided into before (n = 192) and after (n = 457) the publication of the Tokyo guidelines, that is, prior to and including 2007, and from 2008 onward, respectively. We reviewed patient records retrospectively to collect demographic data, biochemical data, radiological findings, and postoperative outcomes. All these factors were compared between the groups.

Results

The duration of symptoms before surgery was significantly longer before 2008 (p = 0.018). ELC was significantly more frequent after 2008 (p = 0.001). Laparoscopic surgery was converted to open surgery in 16.1 % of patients before 2008 vs. 7.8 % of patients after 2008 (p = 0.02). There were no significant differences in bile duct injury or postoperative complications between the groups. The length of preoperative, postoperative, and total hospital stay was longer before 2008.

Conclusions

ELC is a safe and effective therapeutic strategy for AC. The Tokyo guidelines resulted in a significant increase in the number of ELCs being performed and significantly reduced preoperative and total hospital stay without increasing intra- and postoperative complications. Importantly, ELC reduced medical costs, which is crucial for a country with limited resources, such as Tunisia.

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Title: Could the Tokyo guidelines on the management of acute cholecystitis be adopted in developing countries? Experience of one center
Authors: Mahdi Bouassida
Hédi Charrada
Bilel Feidi
Mohamed Fadhel Chtourou
Sélim Sassi
Mohamed Mongi Mighri
Fethi Chebbi
Hassen Touinsi
Publication date: 01-05-2016
Publisher: Springer Japan
Published in: Surgery Today / Issue 5/2016
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI: https://doi.org/10.1007/s00595-015-1207-2

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Could the Tokyo guidelines on the management of acute cholecystitis be adopted in developing countries? Experience of one center

Abstract

Purpose

Methods

Results

Conclusions

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