ArticleSurgical endoscopy2017
Tokyo Guidelines 2013 may be too restrictive and patients with moderate and severe acute cholecystitis can be managed by early cholecystectomy too.
Article in Surgical endoscopy, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 2 of them syntheses that pooled it.
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Who cites it
39 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Should Procalcitonin Be Included in Acute Cholecystitis Guidelines? A Systematic Review.Medicina (Kaunas, Lithuania) · 2023Pooled it
- Readmission to hospital following laparoscopic cholecystectomy: a meta-analysis.Anaesthesiology intensive therapy · 2020Pooled it
- Asymptomatic gallstone disease: Re-evaluating the threshold for surgical options in the era of precision medicine.World journal of gastrointestinal surgery · 2025Review
- The relationship between clinical subtypes, prognosis, and treatment in ICU patients with acute cholangitis using unsupervised machine learning methods.BMC infectious diseases · 2025Article
- Abnormal blood glucose on admission and outcomes in older patients with acute calculous cholecystitis.Biomarkers in medicine · 2025Article
- Management of high-surgical-risk patients with acute cholecystitis following percutaneous cholecystostomy: results of an international Delphi consensus study.International journal of surgery (London, England) · 2025Article
- Mirizzi Syndrome-The Past, Present, and Future.Medicina (Kaunas, Lithuania) · 2023Review
- Early laparoscopic cholecystectomy for acute cholecystitis following the Tokyo Guidelines 2018: a prospective single-center study of 201 consecutive cases.Surgical endoscopy · 2023Article
- Is there a role for percutaneous needle aspiration in the multimodal management of pyogenic liver abscess?Annals of translational medicine · 2023Article
- Primary admission to a surgical service facilitates early cholecystectomy in acute cholecystitis but does not influence patient outcome.Langenbeck's archives of surgery · 2023Article
- Acute Cholecystitis from Biliary Lithiasis: Diagnosis, Management and Treatment.Antibiotics (Basel, Switzerland) · 2023Review
- Cholecystectomy for asymptomatic gallstones: Markov decision tree analysis.World journal of clinical cases · 2022Review
- Pyogenic Liver Abscess Complicating Acute Cholecystitis: Different Management Options.Medicina (Kaunas, Lithuania) · 2022Article
- [Cholecystectomy in acute cholecystitis-a surgical emergency or elective in the next day's program?]Chirurgie (Heidelberg, Germany) · 2022Review
- Image-guided percutaneous cholecystostomy: a comprehensive review.Irish journal of medical science · 2022Review
- The implications and management of complex biliary injuries at a tertiary hepatobiliary specialty center.SAGE open medical case reports · 2022Article
- Validation of TG07 and TG13/TG18 criteria for acute cholangitis and predictors of in-hospital mortality in patients over 80 years old.Clinical and experimental hepatology · 2021Article
- Evaluating the advantages of treating acute cholecystitis by following the Tokyo Guidelines 2018 (TG18): a study emphasizing clinical outcomes and medical expenditures.Surgical endoscopy · 2021Article
- APACHE IV system helps to determine role of cholecystostomy in elderly patients with acute cholecystitis.The Journal of international medical research · 2021Article
- 3D Laparoscopic common bile duct exploration with primary repair by absorbable barbed suture is safe and feasible.Journal of clinical and translational research · 2021Article
Corrections and comments
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Authors and funding
4 authors.
Funding
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Abstract
objectiveThe aim of this study was to determine whether early laparoscopic cholecystectomy (LC) is safe and feasible for patients diagnosed with moderate (grade 2) and severe (grade 3) acute cholecystitis (AC) according to the Tokyo Guidelines 2013 (TG13).
backgroundEarly cholecystectomy is the current accepted standard of care for patients with mild (grade 1) and selected grade 2 AC based on TG13. For selected grade 2 and grade 3 AC, early percutaneous cholecystostomy (PC) followed by delayed cholecystectomy is recommended.
methodsPatients diagnosed with AC over a 14-month period were identified and divided into three grades of AC based upon chart review using the grading and severity indicators according to TG13.
resultsA total of 149 patients underwent emergency LC. Eighty-two (55 %) patients were male. Eighty-four (56.4 %) patients were classified as grade 1 AC, 49 (32.9 %) as grade 2, and 16 (10.7 %) as grade 3. Eighty-three (98.8 %) patients with grade 1 AC underwent emergency LC, and 1 patient (1.2 %) underwent PC followed by emergency LC. The median length of hospital stay for grade 1 AC patients was 2 (1-11) days. There were 2 (2.4 %) readmissions with fever and no additional complications. Among the 65 patients identified with grade 2 or 3 AC, 6 (9.2 %) underwent PC followed by emergency LC. Fifty-nine (90.8 %) patients underwent emergency cholecystectomy: 58 (98.3 %) LC and one (1.7 %) open cholecystectomy. Among the 58 patients with LC, 3 (5.2 %) patients had open conversion and 10 (17.2 %) patients required subtotal cholecystectomy. One patient was converted to open due to bile duct injury and had hepaticojejunostomy repair. Two other patients were converted due to dense adhesions and inability to safely dissect Calot's triangle. The median length of hospital stay was 4 (1-28) days. There was one readmission for ileus.
conclusionSeverity grading of AC is not the sole determinant of early LC. Patient comorbidity also impacts clinical decision. Confirmation in a larger cohort is warranted.
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