Abstract
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.
References
Baird DR, Wilson JP, Mason EM, Duncan TD, Evans JS, Luke JP, et al. An early review of 800 laparoscopic cholecystectomies at a university-affiliated community teaching hospital. Am Surg. 1992;58:206–10.
Jarvinen HJ, Hastbacka J. Early cholecystectomy for acute cholecystitis: a prospective randomized study. Ann Surg. 1980;191:501–5.
Kum CK, Eypasch E, Lefering R, Paul A, Neugebauer E, Troidl H. Laparoscopic cholecystectomy for acute cholecystitis: is it really safe? World J Surg. 1996;20:43–8.
Kiviluoto T, Siren J, Luukkonen P, Kivilaakso E. Randomised trial of laparoscopic versus open cholecystectomy for acute and gangrenous cholecystitis. Lancet. 1998;351:321–5.
Lai PB, Kwong KH, Leung KL, Kwok SP, Chan AC, Chung SC, et al. Randomized trial of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg. 1998;85:764–7.
Lo CM, Liu CL, Fan ST, Lai EC, Wong J. Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg. 1998;227:461–7.
Johansson M, Thune A, Blomqvist A, Nelvin L, Lundell L. Management of acute cholecystitis in the laparoscopic era: results of a prospective, randomized clinical trial. J Gastrointest Surg. 2003;7:642–5.
Kolla SB, Aggarwal S, Kumar A, Kumar R, Chumber S, Parshad R, et al. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective randomized trial. Surg Endosc. 2004;18:1323–7.
Gurusamy K, Samraj K, Gluud C, Wilson E, Davidson BR. Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg. 2010;97:141–50.
Takada T, Kawarada Y, Nimura Y, Yoshida M, Mayumi T, Sekimoto M, et al. Background: Tokyo Guidelines for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Surg. 2007;14:1–10.
Sekimoto M, Takada T, Kawarada Y, Nimura Y, Yoshida M, Mayumi T, et al. Need for criteria for the diagnosis and severity assessment of acute cholangitis and cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007;14:11–4.
Miura F, Takada T, Kawarada Y, Nimura Y, Wada K, Hirota M, et al. Flowcharts for the diagnosis and treatment of acute cholangitis and cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007;14:27–34.
Hirota M, Takada T, Kawarada Y, Nimura Y, Miura F, Hirata K, et al. Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007;14:78–82.
Yoshida M, Takada T, Kawarada Y, Tanaka A, Nimura Y, Gomi H, et al. Antimicrobial therapy for acute cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007;14:83–90.
Yamashita Y, Takada T, Kawarada Y, Nimura Y, Hirota M, Miura F, et al. Surgical treatment of patients with acute cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007;14:91–7.
Yasuda H, Takada T, Kawarada Y, Nimura Y, Hirata K, Kimura Y, et al. Unusual cases of acute cholecystitis and cholangitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007;14:98–113.
Mayumi T, Takada T, Kawarada Y, Nimura Y, Yoshida M, Sekimoto M, et al. Results of the Tokyo Consensus Meeting Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007;14:114–21.
Chang CS, Lee TY, Tung CF, Peng YC. The role of the Tokyo guidelines in the diagnosis of acute calculous cholecystitis. J Hepatobiliary Pancreat Sci. 2010;17:879–84.
Lee SW, Yang SS, Chang CS, Yeh HJ. Impact of the Tokyo guidelines on the management of patients with acute calculous cholecystitis. J Gastroenterol Hepatol. 2009;24:1857–61.
Yokoe M, Takada T, Mayumi T, Yoshida M, Hasegawa H, Norimizu S, et al. Accuracy of the Tokyo Guidelines for the diagnosis of acute cholangitis and cholecystitis taking into consideration the clinical practice pattern in Japan. J Hepatobiliary Pancreat Sci. 2011;18:205–7.
Murata A, Matsuda S, Kuwabara K, Fujino Y, Kubo T, Fujimori K, et al. Evaluation of compliance with the Tokyo Guidelines for the management of acute cholangitis based on the Japanese administrative database associated with the Diagnosis Procedure Combination system. J Hepatobiliary Pancreat Sci. 2011;18:53–9.
Asai K, Watanabe M, Kusachi S, Tanaka H, Matsukiyo H, Osawa A, et al. Bacteriological analysis of bile in acute cholecystitis according to the Tokyo guidelines. J Hepatobiliary Pancreat Sci. 2011;19:476–86.
Griniatsos J, Petrou A, Pappas P, Revenas K, Karavokyros I, Michail OP, et al. Percutaneous cholecystostomy without interval cholecystectomy as definitive treatment of acute cholecystitis in elderly and critically ill patients. South Med J. 2008;101:586–90.
Strasberg SM. Clinical practice. Acute calculous cholecystitis. N Engl J Med. 2008;358:2804–11.
Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis. 2010;50:133–64.
Cameron IC, Chadwick C, Phillips J, Johnson AG. Management of acute cholecystitis in UK hospitals: time for a change. Postgrad Med J. 2004;80:292–4.
Senapati PS, Bhattarcharya D, Harinath G, Ammori BJ. A survey of the timing and approach to the surgical management of cholelithiasis in patients with acute biliary pancreatitis and acute cholecystitis in the UK. Ann R Coll Surg Engl. 2003;85:306–12.
Askew J. A survey of the current surgical treatment of gallstones in Queensland. ANZ J Surg. 2005;75:1086–9.
Vecchio R, MacFadyen BV, Latteri S. Laparoscopic cholecystectomy: an analysis on 114,005 cases of United States series. Int Surg. 1998;83:215–9.
Yamashita Y, Takada T, Hirata K. A survey of the timing and approach to the surgical management of patients with acute cholecystitis in Japanese hospitals. J Hepatobiliary Pancreat Surg. 2006;13:409–15.
Sekimoto M, Imanaka Y, Hirose M, Ishizaki T, Murakami G, Fukata Y, et al. Impact of treatment policies on patient outcomes and resource utilization in acute cholecystitis in Japanese hospitals. BMC Health Serv Res. 2006;6:40.
Conflict of interest
The authors declare no conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Asai, K., Watanabe, M., Kusachi, S. et al. Changes in the therapeutic strategy for acute cholecystitis after the Tokyo guidelines were published. J Hepatobiliary Pancreat Sci 20, 348–355 (2013). https://doi.org/10.1007/s00534-012-0536-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00534-012-0536-4