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Acute cholecystitis: comparing clinical outcomes with TG13 severity and intended laparoscopic versus open cholecystectomy in difficult operative cases

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Abstract

Introduction

The revised Tokyo Guidelines include criteria for determining the severity of acute cholecystitis with treatment algorithms based on severity. The aim of this study was to investigate the relationship of the revised Tokyo Guidelines severity grade to clinical outcomes of cholecystectomy for acute cholecystitis.

Methods

We identified 66 patients with acute cholecystitis from a prior study of difficult cholecystectomy cases. We examined the relationship between severity grade and multiple variables related to perioperative and postoperative outcomes.

Results

A more severe revised Tokyo Guidelines grade was associated with a higher number of complications (p = 0.03) and a higher severity of complications (p = 0.01). Severity grade did not predict operative time, estimated blood loss, intensive care unit admission or length of stay. Compared to planned open cholecystectomy, intended laparoscopic cholecystectomy was associated with significantly fewer total and Clavien–Dindo grade 3 complications, fewer intensive care unit admissions, and shorter length of stay (p values range from 0.03 to < 0.0001).

Conclusion

In technically difficult operations for acute cholecystitis, the revised Tokyo guidelines severity grade correlates with the number and severity of complications. However, intended performance of laparoscopic cholecystectomy rather than open cholecystectomy in difficult operations predicts broader beneficial outcomes than severity grade.

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Authors and Affiliations

  1. Rush University Medical Center, 1750 W. Harrison, Chicago, IL, 60612, USA

    Justin Gerard, Minh B. Luu, Jennifer Poirier & Daniel J. Deziel

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  1. Justin Gerard
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  2. Minh B. Luu
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  3. Jennifer Poirier
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  4. Daniel J. Deziel
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All authors listed have contributed to the creation of this article in accordance with the Journal of Surgical Endoscopy’s guidelines.

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Correspondence to Justin Gerard.

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Disclosures

Justin Gerard has nothing to disclose. Daniel Deziel has nothing to disclose. Minh Luu has nothing to disclose. Jennifer Poirier has nothing to disclose.

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Gerard, J., Luu, M.B., Poirier, J. et al. Acute cholecystitis: comparing clinical outcomes with TG13 severity and intended laparoscopic versus open cholecystectomy in difficult operative cases. Surg Endosc 32, 3943–3948 (2018). https://doi.org/10.1007/s00464-018-6134-z

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  • DOI: https://doi.org/10.1007/s00464-018-6134-z

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