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Changes in the therapeutic strategy for acute cholecystitis after the Tokyo guidelines were published
Author(s) -
Asai Koji,
Watanabe Manabu,
Kusachi Shinya,
Matsukiyo Hiroshi,
Saito Tomoaki,
Kodama Hajime,
Dotai Kojiro,
Hagiwara Osahiko,
Enomoto Toshiyuki,
Nakamura Yoichi,
Okamoto Yasushi,
Saida Yoshihisa,
Nagao Jiro
Publication year - 2013
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1007/s00534-012-0536-4
Subject(s) - medicine , acute cholecystitis , laparoscopic cholecystectomy , cholecystectomy , therapeutic effect , cholecystitis , general surgery , surgery , gallbladder
Background This study examined the feasibility of early laparoscopic cholecystectomy (ELC) for acute cholecystitis (AC) according to the Tokyo guidelines severity grade, and analyzed the changes in the therapeutic strategy for AC after the Tokyo guidelines were published. Methods A total of 225 patients were enrolled in this study. The therapeutic period was divided into two periods: before and after the publication of the Tokyo guidelines (prior to and including 2007, and from 2008, respectively). Results Comparing the surgical strategy between ELC and delayed laparoscopic cholecystectomy (DLC), significant differences were found in the length of preoperative hospital stay and total hospital stay for cases of mild AC compared with moderate AC. With conversion to open surgery, postoperative complications including postoperative bile leak were not significantly different. Since ELC was performed significantly more often after publication of the guidelines, preoperative, postoperative, and total hospital stays were significantly shorter in the later period. Conclusion ELC is a safe and effective therapeutic strategy for both mild and moderate AC. The Tokyo guidelines resulted in a significant increase in the performance of ELC and significantly reduced preoperative and total hospital stays without increasing intra‐ and postoperative complications.