Justin Gerard1, Minh B Luu2, Jennifer Poirier2, Daniel J Deziel2. 1. Rush University Medical Center, 1750 W. Harrison, Chicago, IL, 60612, USA. Justin_Gerard@Rush.edu. 2. Rush University Medical Center, 1750 W. Harrison, Chicago, IL, 60612, USA.
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.
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.
Entities:
Keywords:
Acute cholecystitis; Severity grade; Tokyo guidelines
Authors: G Paul Wright; Kellen Stilwell; Jared Johnson; Matthew T Hefty; Mathew H Chung Journal: J Hepatobiliary Pancreat Sci Date: 2015-09-15 Impact factor: 7.027
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