Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis

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...

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Bibliographic Details
Published in:	Journal of hepato-biliary-pancreatic sciences Vol. 25; no. 1; pp. 55 - 72
Main Authors:	Okamoto, Kohji, Suzuki, Kenji, Takada, Tadahiro, Strasberg, Steven M., Asbun, Horacio J., Endo, Itaru, Iwashita, Yukio, Hibi, Taizo, Pitt, Henry A., Umezawa, Akiko, Asai, Koji, Han, Ho‐Seong, Hwang, Tsann‐Long, Mori, Yasuhisa, Yoon, Yoo‐Seok, Huang, Wayne Shih‐Wei, Belli, Giulio, Dervenis, Christos, Yokoe, Masamichi, Kiriyama, Seiki, Itoi, Takao, Jagannath, Palepu, Garden, O. James, Miura, Fumihiko, Nakamura, Masafumi, Horiguchi, Akihiko, Wakabayashi, Go, Cherqui, Daniel, Santibañes, Eduardo, Shikata, Satoru, Noguchi, Yoshinori, Ukai, Tomohiko, Higuchi, Ryota, Wada, Keita, Honda, Goro, Supe, Avinash Nivritti, Yoshida, Masahiro, Mayumi, Toshihiko, Gouma, Dirk J., Deziel, Daniel J., Liau, Kui‐Hin, Chen, Miin‐Fu, Shibao, Kazunori, Liu, Keng‐Hao, Su, Cheng‐Hsi, Chan, Angus C. W., Yoon, Dong‐Sup, Choi, In‐Seok, Jonas, Eduard, Chen, Xiao‐Ping, Fan, Sheung Tat, Ker, Chen‐Guo, Giménez, Mariano Eduardo, Kitano, Seigo, Inomata, Masafumi, Hirata, Koichi, Inui, Kazuo, Sumiyama, Yoshinobu, Yamamoto, Masakazu
Format:	Journal Article
Language:	English
Published:	Japan Wiley Subscription Services, Inc 01.01.2018
Subjects:	Acute cholecystitis Biliary drainage Cholecystectomy - methods Cholecystectomy, Laparoscopic - adverse effects Cholecystectomy, Laparoscopic - methods Cholecystitis, Acute - diagnostic imaging Cholecystitis, Acute - surgery Conversion to Open Surgery - statistics & numerical data Diagnostic Imaging - methods Disease Management Drainage - methods Female Flowchart Gallbladder diseases Humans Laparoscopic cholecystectomy Male Patients Practice Guidelines as Topic Risk factor Severity of Illness Index Software Design Surgeons Tokyo Biliary drainage Laparoscopic cholecystectomy Flowchart Acute cholecystitis Risk factor
ISSN:	1868-6974, 1868-6982, 1868-6982
Online Access:	Get full text
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Summary:	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. Highlight Okamoto and colleagues propose in the TG18 that some cases of Grade III acute cholecystitis that satisfy certain strict criteria in terms of predictive factor, Charlson Comorbidity Index, and American Society of Anesthesiologists physical status classification can be treated by laparoscopic cholecystectomy if performed at advanced centers by experienced surgeons.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 ObjectType-Article-2 ObjectType-Feature-1 ObjectType-Correspondence-3 ObjectType-Review-4 content type line 23
ISSN:	1868-6974 1868-6982 1868-6982
DOI:	10.1002/jhbp.516