Early Operation for Acute Cholecystitis in the TG18 Era

Abstract

Background: Tokyo Guidelines 2018: Updated Tokyo Guidelines for the management of acute cholangitis/acute cholecystitis (TG18) were released in January 2018. Early laparoscopic cholecystectomy (LC) is recommended for acute cholecystitis within 72 hours when possible or within one week at the latest. Aim: To assess current status of early operation for acute cholecystitis. Methods: From 2018 to 2019, 31 patients who underwent early operation for acute cholecystitis were reviewed retrospectively. Results: During the same period 185 cholecystectomies were performed. Early operations were performed in 17% including 21 males and 10 females, with an average age of 57.9 years. Median time from onset to admission was 1 day. Ultrasonography and CT scans were obtained for all patients and MRCP in 61%. X-ray showed stones in 65% of all patients. Severity score classified into Grade I; 25 patients (81%) and Grade II; 6 patients (19%). Median score of age adjusted Charlson Co-morbidity index was 3 points (0-7). Median time from admission to surgery was 1 day, and 61% underwent LC and 39% open cholecystectomy (OC). In Grade II patients, OC was performed in 83% because of a pericholecystic abscess with severe inflammation. Subtotal cholecystectomy was selected in 50% patients as a bailout procedure. Morbidity rate was 6%. Average postoperative hospital stay was 5.9 days. Conclusions: According to the flowcharts in TG18, early LC is recommended for all patients, but OC was chosen in 39% in this series. OC does not make cholecystectomy easier, but OC must be considered when OC is safer.