Risk factors for difficulty of laparoscopic cholecystectomy in grade II acute cholecystitis according to the Tokyo guidelines 2013

Introduction: Acute Calculous Cholecystitis is a condition in which the gallbladder becomes inflamed due to cholelithiasis. Early diagnosis, severity grading and appropriate intervention reduce both morbidity and mortality. The aim of this prospective study is to correlate the severity with the outcome of acute calculous cholecystitis according to Tokyo Guidelines. Methods: This was a hospital based prospective study conducted in the Department of Surgery, Nepalgunj Medical College Teaching Hospital for a period of two years from April 2017 to March 2019. The patients were classified into three groups according to the severity grading in the Tokyo guidelines (TG18/ TG13). Clinical characteristics among these patients were analyzed for comparison. Results: Among all diagnostic criteria, right upper quarter (RUQ)h abdominal pain (94%) Murphy's sign (94%) and thickened gallbladder wall (80%) had the highest sensitivity rates (p<0.032), whereas elevated white cell count (32%) and RUQ abdominal mass (32%) had the lowest sensitivity rates (p<0.035). Higher sensitivity rates of diagnostic criteria were related to severe cholecystitis, except for Fever (46%) and elevated white blood cell (WBC) count (32%). All the 28 patients in grade I and selected patients 3 out of 6in grade II underwent early laparoscopic cholecystectomy (LC) without any conversion and increased morbidity and mortality. Out of16 patients in grade III there was 2 mortalities due to ARDS, 1 needed Ultrasonography (USG) guided cholecystostomy, 1 underwent emergency cholecystectomy. 16 patients, 3 in grade II and 13 in grade III underwent interval laparoscopic cholecystectomy safely. There were no major postoperative morbidities except for superficial surgical site infection (SSI) in 1 patient in grade III who underwent emergency cholecystectomy Higher grade of severity was associated with increased morbidity and mortality (p<0.03). Conclusion: A combination of diagnostic criteria with different path physiologic findings, as noted in the Tokyo guidelines, can help clinicians make the correct diagnosis for patients with acute cholecystitis and there was strong correlation between the severity and outcomes of acute cholecystitis.

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Early Laparoscopic Cholecystectomy for Acute Cholecystitis in Accordance with the Tokyo Guidelines for the Management of Acute Cholangitis and Cholecystitis

General Medicine Open Access ◽

10.4172/2327-5146.1000127 ◽

2014 ◽

Vol 02 (01) ◽

Author(s):

Nobuo Seo Keiji Ohota

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Acute Cholangitis ◽

Tokyo Guidelines ◽

Early Laparoscopic Cholecystectomy

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Risk factors for conversion of laparoscopic cholecystectomy to open surgery associated with the severity characteristics according to the Tokyo guidelines

Surgery Today ◽

10.1007/s00595-014-0838-z ◽

2014 ◽

Vol 44 (12) ◽

pp. 2300-2304 ◽

Cited By ~ 28

Author(s):

Koji Asai ◽

Manabu Watanabe ◽

Shinya Kusachi ◽

Hiroshi Matsukiyo ◽

Tomoaki Saito ◽

...

Keyword(s):

Risk Factors ◽

Laparoscopic Cholecystectomy ◽

Open Surgery ◽

Tokyo Guidelines

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COVID-19 outbreak and acute cholecystitis in a Hub Hospital in Milan: wider indications for percutaneous cholecystostomy

BMC Surgery ◽

10.1186/s12893-021-01137-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Matteo Barabino ◽

Gaetano Piccolo ◽

Arianna Trizzino ◽

Veronica Fedele ◽

Carlo Ferrari ◽

...

Keyword(s):

Acute Cholecystitis ◽

Percutaneous Cholecystostomy ◽

Disease Evolution ◽

Tokyo Guidelines ◽

Gallbladder Drainage ◽

National Health Care ◽

Percutaneous Transhepatic Gallbladder Drainage ◽

Italian National Health ◽

Grade Ii ◽

The Mean

Abstract Background COVID-19 pandemic has impacted the Italian National Health Care system at many different levels, causing a complete reorganization of surgical wards. In this context, our study retrospectively analysed the management strategy for patients with acute cholecystitis. Methods We analysed all patients admitted to our Emergency Department for acute cholecystitis between February and April 2020 and we graded each case according to 2018 Tokyo Guidelines. All patients were tested for positivity to SARS-CoV-2 and received an initial conservative treatment. We focused on patients submitted to cholecystostomy during the acute phase of pandemic and their subsequent disease evolution. Results Thirty-seven patients were admitted for acute cholecystitis (13 grade I, 16 grade II, 8 grade III). According to Tokyo Guidelines (2018), patients were successfully treated with antibiotic only, bedside percutaneous transhepatic gallbladder drainage (PC) and laparoscopic cholecystectomy (LC) in 29.7%, 21.6% and 48.7% of cases respectively. Therapeutic strategy of three out of 8 cases, otherwise fit for surgery, submitted to bedside percutaneous transhepatic gallbladder drainage (37.5%), were directly modified by COVID-19 pandemic: one due to the SARS-CoV-2 positivity, while two others due to unavailability of operating room and intensive care unit for post-operative monitoring respectively. Overall success rate of percutaneous cholecystostomy was of 87.5%. The mean post-procedural hospitalization length was 9 days, and no related adverse events were observed apart from transient parietal bleeding, conservatively treated. Once discharged, two patients required readmission because of acute biliary symptoms. Median time of drainage removal was 43 days and only 50% patients thereafter underwent cholecystectomy. Conclusions Percutaneous cholecystostomy has shown to be an effective and safe treatment thus acquiring an increased relevance in the first phase of the pandemic. Nowadays, considering we are forced to live with the SARS-CoV-2 virus, PC should be considered as a virtuous, alternative tool for potentially all COVID-19 positive patients and selectively for negative cases unresponsive to conservative therapy and unfit for surgery.

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Laparoscopic subtotal cholecystectomy for difficult cases of acute cholecystitis: a simple technique using barbed sutures

Surgical Case Reports ◽

10.1186/s40792-020-01026-1 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Sho Fujiwara ◽

Kenji Kaino ◽

Kazuki Iseya ◽

Nozomi Koyamada

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Cystic Duct ◽

Severe Heart Failure ◽

Pathological Diagnosis ◽

Barbed Suture ◽

Barbed Sutures ◽

Subtotal Cholecystectomy ◽

Grade Ii

Abstract Background Laparoscopic cholecystectomy (LC) for difficult acute cholecystitis (AC) cases bears a high risk of vasculobiliary injuries (VBI). The Tokyo Guidelines 2018 (TG18) recommend the use of bailout procedures and subtotal cholecystectomy to prevent VBI. Performing a safe LC is challenging, even when followed by an accurate pre-surgical assessment. Laparoscopic cholecystectomy (LSC) requires advanced skills, and there is a risk of recurrence of cancer and/or gallbladder stones (GBS) in the remnant gallbladder (GB). Moreover, it is sometimes impossible to safely close the cystic duct with either a loop tie or linear staples because of anatomical and fragility problems. Here, we report a novel technique employing barbed sutures for LSC in difficult AC cases. Case presentation We performed urgent LSC using barbed sutures for the stump of the cystic duct in two patients. In preoperative assessments, we found that these cases were qualified for operations rather than GB drainages, but the cystic ducts appeared difficult to close due to their severe inflammation and fragility during the operations. We applied barbed suture as a surrogate technique to close the stump of cystic duct. In patient 1, a 67-year-old woman with severe heart failure and type 2 diabetes mellitus was diagnosed with grade III AC. Pathological diagnosis was gangrenous cholecystitis. In patient 2, a 68-year-old woman who was referred to our hospital after 15 days of treatment for AC with antibiotics without drainage. The severity of AC was grade II according to TG18. Pathological diagnosis was acute-on-chronic cholecystitis. Both patients were discharged without complication. Conclusions The utilization of barbed sutures in LSC stems as a feasible and safe surrogate technique. Furthermore, this approach could decrease the risks associated with the remnant GB.

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Percutaneous transhepatic gallbladder drainage followed by laparoscopic cholecystectomy for acute cholecystitis

Vietnam Journal of Endolaparoscopic Surgery ◽

10.51199/vjsel.2020.4.2 ◽

2020 ◽

Vol 10 (4) ◽

Author(s):

Minh Hai Pham ◽

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Medical Center ◽

Case Series ◽

Morbidity Rate ◽

Safe Procedure ◽

Gallbladder Drainage ◽

Percutaneous Transhepatic Gallbladder Drainage ◽

Grade Ii ◽

Grade Iii

Abstract Introduction: Laparoscopic cholecystectomy (LC) has been considered as main treatment for acute cholecystitis due to gallstones. However, LC is not entirely safe for patients with severe comorbidities, high risk of surgery. In such circumstances, two-stage treatment including percutaneous transhepatic gallbladder drainage (PTGBD) first and then LC is an appropriate choice. PTGBD followed by LC or LC after PTGBD might be technically difficult. This article was written to evaluate the feasibility and the safety of PTGBD followed by LC (PTGBD + LC). Materials and Methods: This case series report was conducted on patients who underwent PTGBD + LC in University Medical Center, Ho Chi Minh City, Vietnam, from June 2018 to June 2020. We applied TG 2018 criteria for diagnosis and severity grading of cholecystitis in all patients. The comorbidities were evaluted according to Charlson comorbidity index (CCI) and American Society of Anesthesiologists physical status (ASA-PS) classification. Indications for PTGBD were grade II or grade III acute cholecystitis and the presence of a severe comorbidities (CCI > 6 and/or ASA > III). Results: From June 2018 to June 2020, there were 13 cases performed PTGBD + LC. There were 84,6% of grade II cholecystitis cases and 15,4% of grade III cholecystitis cases according to Tokyo guidelines 2018 criteria with comorbidities (30,8% of cases with CCI > 6, 100% of cases with ASA > III). Mean operative time: 126 minutes; one case needed transfusion due to bleeding from gallbladder inflammatory; no conversion to open surgery; morbidity rate was 23,1% (1 bile leakage successfully treated with preservation, 1 surgical site infection, 1 pneumoniae); mean hospital stay was 5,25 days; no mortality was observed in this series. Conclusions: PTGBD followed up by LC is feasible and safe procedure for acute cholecystitis in selected patients.

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Response to the comment on “Tokyo Guidelines 2018: Surgical management of acute cholecystitis: Safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos)”

Journal of Hepato-Biliary-Pancreatic Sciences ◽

10.1002/jhbp.851 ◽

2020 ◽

Vol 27 (11) ◽

Author(s):

Go Wakabayashi ◽

Tadahiro Takada

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Surgical Management ◽

Tokyo Guidelines

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Risk factors influencing conversion of laparoscopic cholecystectomy to open cholecystectomy

International Surgery Journal ◽

10.18203/2349-2902.isj20174495 ◽

2017 ◽

Vol 4 (10) ◽

pp. 3354

Author(s):

Mohanapriya Thyagarajan ◽

Balaji Singh ◽

Arulappan Thangasamy ◽

Shobana Rajasekar

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Wall Thickness ◽

Open Cholecystectomy ◽

Gallbladder Wall ◽

Related Factors ◽

Previous Episode ◽

Factors Influencing

Background: Gall stone disease is a common disease affecting human beings. Over the past two decades, laparoscopic cholecystectomy has become gold standard for the surgical treatment of gallbladder disease. The advantages of laparoscopic cholecystectomy over open surgery are a shorter hospital stay, less postoperative pain, faster recovery, better cosmoses. This study was planned to identify the circumstances and the risk factors influencing the conversion of laparoscopic cholecystectomy to open procedure.Methods: This is a Prospective study conducted over a period of 24 months. A total of 50/500 patients who were electively posted for laparoscopic cholecystectomy and got converted into open cholecyctectomy were included in the study. The Factors recorded and analysed were Age and Sex of the patient, presence of diabetes mellitus, previous episode of Acute Cholecystitis, Body Mass Index, presence of abdominal scar, total count, Ultrasonagram Abdomen findings of Gallbladder wall thickness and presence of pericholecystic fluid.Results: In our study, it has been observed that Patient Related Factors - Age >50yrs, Male gender, Presence of Diabetes Mellitus, Obesity, previous Abdominal surgeries and Disease Related Factors - previous episode of Acute Cholecystitis, presence of Acute Cholecystitis, Gallbladder wall thickness >4mm, presence of Pericholecystic fluid were found to be significant risk factors in conversion of laparoscopic to open cholecystectomy.Conclusions: These risk factors help to predict the difficulty of the procedure and this would permit the surgeon to better inform patients about the risk of conversion from laparoscopic to open cholecystectomy.

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