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J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):55-72. doi: 10.1002/jhbp.516. Epub 2017 Dec 20.

Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis.

Author information

1
Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Fukuoka, Japan.
2
Department of Surgery, Fujinomiya City General Hospital, Shizuoka, Japan.
3
Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
4
Section of Hepato-Pancreato-Biliary Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
5
Department of Surgery, Mayo Clinic College of Medicine, Jacksonville, FL, USA.
6
Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan.
7
Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan.
8
Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
9
Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
10
Minimally Invasive Surgery Center, Yotsuya Medical Cube, Tokyo, Japan.
11
Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan.
12
Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.
13
Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
14
Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
15
Department of Surgery, Show Chwan Memorial Hospital, Changhua, Taiwan.
16
Department of General and HPB Surgery, Loreto Nuovo Hospital, Naples, Italy.
17
First Department of Surgery, Agia Olga Hospital, Athens, Greece.
18
Department of General Internal Medicine, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan.
19
Department of Gastroenterology, Ogaki Municipal Hospital, Gifu, Japan.
20
Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan.
21
Department of Surgical Oncology, Lilavati Hospital and Research Centre, Mumbai, India.
22
Clinical Surgery, University of Edinburgh, Edinburgh, UK.
23
Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Aichi, Japan.
24
Department of Surgery, Ageo Central General Hospital, Saitama, Japan.
25
Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France.
26
Department of Surgery, Hospital Italiano, University of Buenos Aires, Buenos Aires, Argentina.
27
Director, Mie Prefectural Ichishi Hospital, Mie, Japan.
28
Department of Family Medicine, Mie Prefectural Ichishi Hospital, Mie, Japan.
29
Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
30
Department of Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.
31
Department of Surgical Gastroenterology, Seth G S Medical College and K E M Hospital, Mumbai, , India.
32
Department of Hemodialysis and Surgery, Ichikawa Hospital, International University of Health and Welfare, Chiba, Japan.
33
Department of EBM and Guidelines, Japan Council for Quality Health Care, Tokyo, Japan.
34
Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan.
35
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
36
Department of Surgery, Rush University Medical Center, Chicago, IL, USA.
37
Liau KH Consulting PL, Mt Elizabeth Novena Hospital, Singapore Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
38
Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan.
39
Department of Surgery, Cheng Hsin General Hospital, Taipei, Taiwan.
40
Surgery Centre, Department of Surgery, Hong Kong Sanatorium and Hospital, Hong Kong, Hong Kong.
41
Department of Surgery, Yonsei University Gangnam Severance Hospital, Seoul, Korea.
42
Department of Surgery, Konyang University Hospital, Daejeon, Korea.
43
Surgical Gastroenterology/Hepatopancreatobiliary Unit, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
44
Hepatic Surgery Centre, Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
45
Director, Liver Surgery Centre, Hong Kong Sanatorium and Hospital, Hong Kong, Hong Kong.
46
Department of Surgery, Yuan's General Hospital, Kaohsiung, Taiwan.
47
Chair of General Surgery and Minimal Invasive Surgery "Taquini", University of Buenos Aires, DAICIM Foundation, Buenos Aires, Argentina.
48
President, Oita University, Oita, Japan.
49
Department of Surgery, JR Sapporo Hospital, Hokkaido, Japan.
50
Department of Gastroenterology, Second Teaching Hospital, Fujita Health University, Aichi, Japan.
51
Director, Toho University, Tokyo, Japan.

Abstract

We propose a new flowchart for the treatment of acute cholecystitis (AC) in the Tokyo Guidelines 2018 (TG18). Grade III AC was not indicated for straightforward laparoscopic cholecystectomy (Lap-C). Following analysis of subsequent clinical investigations and drawing on Big Data in particular, TG18 proposes that some Grade III AC can be treated by Lap-C when performed at advanced centers with specialized surgeons experienced in this procedure and for patients that satisfy certain strict criteria. For Grade I, TG18 recommends early Lap-C if the patients meet the criteria of Charlson comorbidity index (CCI) ≤5 and American Society of Anesthesiologists physical status classification (ASA-PS) ≤2. For Grade II AC, if patients meet the criteria of CCI ≤5 and ASA-PS ≤2, TG18 recommends early Lap-C performed by experienced surgeons; and if not, after medical treatment and/or gallbladder drainage, Lap-C would be indicated. TG18 proposes that Lap-C is indicated in Grade III patients with strict criteria. These are that the patients have favorable organ system failure, and negative predictive factors, who meet the criteria of CCI ≤3 and ASA-PS ≤2 and who are being treated at an advanced center (where experienced surgeons practice). If the patient is not considered suitable for early surgery, TG18 recommends early/urgent biliary drainage followed by delayed Lap-C once the patient's overall condition has improved. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.

KEYWORDS:

Acute cholecystitis; Biliary drainage; Flowchart; Laparoscopic cholecystectomy; Risk factor

PMID:
29045062
DOI:
10.1002/jhbp.516
[Indexed for MEDLINE]

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