Evaluation of Tokyo guideline 2013 efficacy by aggressive urgent cholecystectomy for acute cholecystitis

Abstract

Aim: This study investigated that the efficacy of delayed cholecystectomy in patients with acute cholecystitis (AC), the optimal timing and usefulness of early cholecystectomy for AC in patients with comorbid acute cholangitis. Methods: Between 2011 and 2016, 252 patients underwent early cholecystectomy for AC. Patients underwent operation with early phase operation group (EO group) and late phase operation group (LO) group. Surgical outcomes were analyzed for these two groups with propensity score analysis. Outcomes were compared between patients with and without comorbid acute cholangitis. In the subgroup analysis, outcomes of patients with comorbid acute cholangitis who underwent urgent cholecystectomy and semi-urgent were compared. Results: A total of 164 patients with G1 and 2 cholecystitis were underwent emergency cholecystectomy. The rate of conversion to open procedure, operation time, intraoperative bleeding, and complications were equivalent in these two groups. After one to two propensity score matched analysis outcomes of LO group were not inferior to those of EO group. Patients had comorbid acute cholangitis or non-acute cholangitis. There were no significant differences in postoperative complication rate, operation time, or intraoperative blood loss between these groups. In the acute cholangitis subgroup analysis, urgent and semi-urgent cholecystectomy had comparable intra- and postoperative outcomes. Conclusion: Our study demonstrated the feasibility and safety of performing cholecystectomy within 4-7 days from symptom onset, as the 72-h limit is not necessarily required for experienced laparoscopic surgeons and institutions. Early cholecystectomy within 14 days after symptom onset was safely performed for patients with after successful AC treatment.