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Surgical Endoscopy

Published in:

01-07-2017

Tokyo Guidelines 2013 may be too restrictive and patients with moderate and severe acute cholecystitis can be managed by early cholecystectomy too

Authors: Vinoban Amirthalingam, Jee Keem Low, Winston Woon, Vishalkumar Shelat

Published in: Surgical Endoscopy | Issue 7/2017

Abstract

Objective

The aim of this study was to determine whether early laparoscopic cholecystectomy (LC) is safe and feasible for patients diagnosed with moderate (grade 2) and severe (grade 3) acute cholecystitis (AC) according to the Tokyo Guidelines 2013 (TG13).

Background

Early cholecystectomy is the current accepted standard of care for patients with mild (grade 1) and selected grade 2 AC based on TG13. For selected grade 2 and grade 3 AC, early percutaneous cholecystostomy (PC) followed by delayed cholecystectomy is recommended.

Methods

Patients diagnosed with AC over a 14-month period were identified and divided into three grades of AC based upon chart review using the grading and severity indicators according to TG13.

Results

A total of 149 patients underwent emergency LC. Eighty-two (55 %) patients were male. Eighty-four (56.4 %) patients were classified as grade 1 AC, 49 (32.9 %) as grade 2, and 16 (10.7 %) as grade 3. Eighty-three (98.8 %) patients with grade 1 AC underwent emergency LC, and 1 patient (1.2 %) underwent PC followed by emergency LC. The median length of hospital stay for grade 1 AC patients was 2 (1–11) days. There were 2 (2.4 %) readmissions with fever and no additional complications. Among the 65 patients identified with grade 2 or 3 AC, 6 (9.2 %) underwent PC followed by emergency LC. Fifty-nine (90.8 %) patients underwent emergency cholecystectomy: 58 (98.3 %) LC and one (1.7 %) open cholecystectomy. Among the 58 patients with LC, 3 (5.2 %) patients had open conversion and 10 (17.2 %) patients required subtotal cholecystectomy. One patient was converted to open due to bile duct injury and had hepaticojejunostomy repair. Two other patients were converted due to dense adhesions and inability to safely dissect Calot’s triangle. The median length of hospital stay was 4 (1–28) days. There was one readmission for ileus.

Conclusion

Severity grading of AC is not the sole determinant of early LC. Patient comorbidity also impacts clinical decision. Confirmation in a larger cohort is warranted.

Halldestam I, Enell EL, Kullman E, Borch K (2004) Development of symptoms and complications in individuals with asymptomatic gallstones. Br J Surg 91:734–738CrossRefPubMed

Behari A, Kapoor VK (2012) Asymptomatic gallstones (AsGS)—to treat or not to? Indian J Surg 74:4–12CrossRefPubMed

Yokoe M, Takada T, Strasberg SM et al (2013) TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci 20:35–46CrossRefPubMed

Miura F, Takada T, Strasberg SM et al (2013) TG13 flowchart for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci 20:47–54CrossRefPubMed

Yamashita Y, Takada T, Strasberg SM et al (2013) TG13 surgical management of acute cholecystitis. J Hepatobiliary Pancreat Sci 20:89–96CrossRefPubMed

Yamashita Y, Takada T, Kawarada Y et al (2007) Surgical treatment of patients with acute cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg 14:91–97CrossRefPubMedPubMedCentral

Parker MJ, Gurusamy K, Stoker M (2004) Surgery in elderly patients. Curr Orthop 18(5):333–344CrossRef

Tornqvist B, Waage A, Zheng Z, Ye W, Nilsson M (2016) Severity of acute cholecystitis and risk of iatrogenic bile duct injury during cholecystectomy, a population-based case-control study. World J Surg 40(5):1060–1067CrossRefPubMed

Yeo CS, Tay VM, Low JK, Woon WW, Punamiya SJ, Shelat VG (2016) Outcomes of percutaneous cholecystostomy and predictors of eventual cholecystectomy. J Hepatobiliary Pancreat Sci 23(1):65–73CrossRefPubMed

10.

Kimura T, Suzuki K, Umehara Y, Kawabe A, Wada H (2005) Features and management of bile leaks after laparoscopic cholecystectomy. J Hepato-Biliary-Pancreat Surg 12(1):61–64CrossRef

11.

Mizrahi I, Mazeh H, Yuval JB, Almogy G, Bala M, Simanovski N et al (2015) Perioperative outcomes of delayed laparoscopic cholecystectomy for acute calculous cholecystitis with and without percutaneous cholecystostomy. Surgery 158:728–735CrossRefPubMed

12.

Melloul E, Denys A, Demartines N, Calmes JM, Schafer M (2011) Percutaneous drainage versus emergency cholecystectomy for the treatment of acute cholecystitis in critically ill patients: does it matter? World J Surg 35:826–833CrossRefPubMed

13.

CharlsonME PompeiP, AlesKL MacKenzieCR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRef

14.

Gurusamy KS, Samraj K (2006) Early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Cochrane Database Syst Rev. doi:10.1002/14651858.CD005440.pub2

15.

Croo Alexander, De Wolf Edward, Boterbergh Kim, Vanlander Aude, Peeters Harald, Troisi Roberto, Berrevoet Frederik (2014) Laparoscopic cholecystectomy in acute cholecystitis: support for an early interval surgery. Acta Gastro-Enterol Belg 77(3):306–311

16.

Minutolo V, Liccicardello A, Arena M, Nicosia A, Di Stefano B, Cali G, Arena G (2014) Laparoscopic cholecystectomy in the treatment of acute cholecystitis: comparison of outcomes and costs between early and delayed cholecystectomy. Eur Rev Med Pharmacol Sci 18:40–46PubMed

17.

Roulin D, Saadi A, Di Mare L, Demartines N, Halkic N (2016) Early versus delayed cholecystectomy for acute cholecystitis, are the 72 hours still the rule? A randomized trial. Ann Surg 264(5):717–722.CrossRefPubMed

18.

Borzellino G, Sauerland S, Minicozzi AM et al (2008) Laparoscopic cholecystectomy for severe acute cholecystitis. A meta-analysis of results. Surg Endosc 22:8–15CrossRefPubMed

19.

Sartelli M, Weber DG, Ruppe E, Bassetti M, Wright BJ, Ansaloni L et al (2016) Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA). World J Emerg Surg 11:33. doi:10.1186/s13017-016-0089-y CrossRefPubMedPubMedCentral

20.

Ahmed S, Chia CLK, Junnarkar SP, Woon W, Shelat VG (2016) Percutaneous drainage for giant pyogenic liver abscess—is it safe and sufficient? Am J Surg 211:95–101CrossRefPubMed

21.

Shelat VG, Chia CLK, Yeo CSW, Qiao W, Woon W, Junnarkar SP (2015) Pyogenic liver abscess: does Escherichia coli cause more adverse outcomes than Klebsiella Pneumoniae? World J Surg 39:2535–2542CrossRefPubMed

22.

Bourgouin S, Mancini J, Monchal T, Calvary R, Bordes J, Balandraud P (2016) How to predict difficult laparoscopic cholecystectomy? Proposal for a simple preoperative scoring system. Am J Surg. doi:10.1016/j.amjsurg.2016.04.003 PubMed

23.

Beksac K, Turhan N, Karaagaoglu E, Abbasoglu O (2016) Risk factors for conversion of laparoscopic cholecystectomy to open surgery: a new predictive statistical model. J Laparoendosc Adv Surg Tech A 26(9):693–696

24.

Shelat VG, Chia JM, Low JK (2015) Common bile duct exploration in an elderly Asian population. Int Surg 100:261–267CrossRefPubMedPubMedCentral

25.

Tan KK, Shelat VG, Liau KH, Chan CY, Ho CK (2010) Laparoscopic common bile duct exploration: our first 50 cases. Ann Acad Med Singap 39:136–142PubMed

26.

Shelat VG, Chan CY, Liau KH, Ho CK (2012) Laparoscopic exploration can salvage failed endoscopic bile duct stone extraction. Singap Med J 53:313–317

27.

Kamalapurkar D, Pang TC, Siriwardhane M, Hollands M, Johnston E, Pleass H et al (2015) Index cholecystectomy in grade II and III acute calculous cholecystitis is feasible and safe. ANZ J Surg. doi:10.1111/ans.12986 PubMed

28.

Nakajima J, Sasaki A, Obuchi T, Baba S, Nitta H, Wakabayashi G (2009) Laparoscopic subtotal cholecystectomy for severe cholecystitis. Surg Today 39:870–875CrossRefPubMed

29.

Chia CL, Shelat VG, Low W, George S, Rao J (2014) The use of Collatamp G, local gentamicin-collagen sponge in reducing wound infection. Int Surg 99:565–570CrossRefPubMedPubMedCentral

30.

Liau KH, Aung KT, Chua N, Ho CK, Chan CY, Kow AW et al (2010) Outcome of a strategy to reduce surgical site infection in a tertiary-care hospital. Surg Infect (Larchmt) 11:151–159CrossRef

31.

Ansaloni L, Pisano M, Coccolini F, Peitzmann AB, Fingerhut A, Catena F et al (2016) 2016 WSES guidelines on acute calculous cholecystitis. World J Emerg Surg 11:25. doi:10.1186/s13017-016-0082-5 CrossRefPubMedPubMedCentral

Title: Tokyo Guidelines 2013 may be too restrictive and patients with moderate and severe acute cholecystitis can be managed by early cholecystectomy too
Authors: Vinoban Amirthalingam
Jee Keem Low
Winston Woon
Vishalkumar Shelat
Publication date: 01-07-2017
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 7/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-016-5300-4

At a glance: The STEP trials

Springer Medicine

Tokyo Guidelines 2013 may be too restrictive and patients with moderate and severe acute cholecystitis can be managed by early cholecystectomy too

Abstract

Objective

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Background

Methods

Results

Conclusion

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