Mahdi Bouassida1, Hédi Charrada2, Bilel Feidi3, Mohamed Fadhel Chtourou3, Sélim Sassi3, Mohamed Mongi Mighri3, Fethi Chebbi3, Hassen Touinsi3. 1. Department of Surgery, Faculty of Medicine of Tunis, Mohamed Tahar Maamouri Hospital, Mrazga, 8000, Nabeul, Tunisia. bouassidamahdi@yahoo.fr. 2. Department of Reanimation, Faculty of Medicine of Tunis, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia. 3. Department of Surgery, Faculty of Medicine of Tunis, Mohamed Tahar Maamouri Hospital, Mrazga, 8000, Nabeul, Tunisia.
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.
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.
Entities:
Keywords:
Acute cholecystitis; Early laparoscopic cholecystectomy; Tokyo guidelines
Authors: Yuichi Yamashita; Tadahiro Takada; Steven M Strasberg; Henry A Pitt; Dirk J Gouma; O James Garden; Markus W Büchler; Harumi Gomi; Christos Dervenis; John A Windsor; Sun-Whe Kim; Eduardo de Santibanes; Robert Padbury; Xiao-Ping Chen; Angus C W Chan; Sheung-Tat Fan; Palepu Jagannath; Toshihiko Mayumi; Masahiro Yoshida; Fumihiko Miura; Toshio Tsuyuguchi; Takao Itoi; Avinash N Supe Journal: J Hepatobiliary Pancreat Sci Date: 2013-01 Impact factor: 7.027
Authors: Masahiko Hirota; Tadahiro Takada; Yoshifumi Kawarada; Yuji Nimura; Fumihiko Miura; Koichi Hirata; Toshihiko Mayumi; Masahiro Yoshida; Steven Strasberg; Henry Pitt; Thomas R Gadacz; Eduardo de Santibanes; Dirk J Gouma; Joseph S Solomkin; Jacques Belghiti; Horst Neuhaus; Markus W Büchler; Sheung-Tat Fan; Chen-Guo Ker; Robert T Padbury; Kui-Hin Liau; Serafin C Hilvano; Giulio Belli; John A Windsor; Christos Dervenis Journal: J Hepatobiliary Pancreat Surg Date: 2007-01-30