Evaluating the timing of laparoscopic cholecystectomy for acute cholecystitis in an experienced center based on propensity score matching

Asai, Koji; Watanabe, Manabu; Kusachi, Shozo; Miyata, Hiroshi; Saito, Tomoaki; Ishii, Tomotaka; Kujiraoka, Manabu; Katagiri, Miwa; Katada, Natsuya; Saida, Yoshihisa

doi:10.1111/ases.12353

Cited by 8 publications

(6 citation statements)

References 31 publications

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“…Although standard treatment for patients with acute cholecystitis (AC) is well established based on the 2007 Tokyo Guidelines (TG07) , revised in Tokyo Guidelines 2013 (TG13) , morbidity and mortality rates in patients at high risk for surgery with comorbid medical conditions remain high . In TG07, the detailed procedure of percutaneous transhepatic gallbladder drainage (PTGBD) was introduced, while the recommendation of PTGBD for AC was not established.…”

Section: Introductionmentioning

confidence: 99%

Tokyo Guidelines 2018: management strategies for gallbladder drainage in patients with acute cholecystitis (with videos)

Mori

Itoi

Baron

et al. 2017

J Hepato Biliary Pancreat

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238

196

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Since the publication of the Tokyo Guidelines in 2007 and their revision in 2013, appropriate management for acute cholecystitis has been more clearly established. Since the last revision, several manuscripts, especially for alternative endoscopic techniques, have been reported; therefore, additional evaluation and refinement of the 2013 Guidelines is required. We describe a standard drainage method for surgically high‐risk patients with acute cholecystitis and the latest developed endoscopic gallbladder drainage techniques described in the updated Tokyo Guidelines 2018 (TG18). Our study confirmed that percutaneous transhepatic gallbladder drainage should be considered the first alternative to surgical intervention in surgically high‐risk patients with acute cholecystitis. Also, endoscopic transpapillary gallbladder drainage or endoscopic ultrasound‐guided gallbladder drainage can be considered in high‐volume institutes by skilled endoscopists. In the endoscopic transpapillary approach, either endoscopic naso‐gallbladder drainage or gallbladder stenting can be considered for gallbladder drainage. We also introduce special techniques and the latest outcomes of endoscopic ultrasound‐guided gallbladder drainage studies. 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.

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Section: Introductionmentioning

confidence: 99%

Tokyo Guidelines 2018: management strategies for gallbladder drainage in patients with acute cholecystitis (with videos)

Mori

Itoi

Baron

et al. 2017

J Hepato Biliary Pancreat

Self Cite

238

196

View full text Add to dashboard Cite

show abstract

“…Likewise, a massive observational prospective study by Endo et al, compared four strategies (antibiotic therapy, cholecystostomy either as a de nitive treatment or as a bridge to surgery, and early cholecystectomy). Their results supported early cholecystectomy over any other strategy, with or without cholecystostomy 41 . ST is the rst option in the management of ACC crystallized in the CHOCOLATE trial, which encouraged early laparoscopia cholecystectomy over cholecystostomy 40 .…”

Section: Treatment Modalitiesmentioning

confidence: 74%

Mortality Risk Estimation in Acute Calculous Cholecystitis: Beyond the Tokyo Guidelines

González-Castillo

Sancho-Insenser

Miguel-Palacio

et al. 2021

Preprint

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Background: Acute Calculous Cholecystitis (ACC) is the second most frequent surgical condition in Emergency Departments. The recommended treatment is the Early Laparoscopic Cholecystectomy, however, the Tokyo Guidelines (TG) advocate for different initial treatments in some subgroups of patients without a strong evidence that all patients will benefit from them. There is no clear consensus in the literature about who is the unfit patients for surgical treatment. The objective of the study is to identify the risk factors for mortality in ACC and compare them with Tokyo Guidelines (TG) classification.Methods: retrospective unicentric cohort study of patients emergently admitted with and ACC during January 1, 2011 to December 31, 2016. The study comprised 963 patients. Primary outcome was the mortality after the diagnosis. A propensity score method was used to avoid confunding factors comparing surgical treatment and non-surgical treatment.Results: the overall mortality was 3.6%. Mortality was associated with older age (68 + IQR 27 vs. 83 + IQR 5.5; P 0.001) and higher Charlson Comorbidity Index (3.5 + 5.3 vs. 0+2; P 0.001). A logistic regression model isolated four mortality risk factors (ACME): chronic obstructive pulmonary disease (OR 4.66:95%CI: 1.7-12.8 P=0.001), dementia (OR 4.12;95%CI: 1.34-12.7 P=0.001), age > 80 years (OR 1.12:95% CI: 1.02-1.21 P=0.001) and the need of preoperative vasoactive amines (OR 9.9:95%CI: 3.5-28.3 P=0.001) which predicted the mortality in a 92% of the patients. The receiver operating characteristic curve yielded an area of 88% significantly higher that 68% (P=0.003) from the TG classification. When comparing subgroups selected using propensity score matching with the same morbidity and severity of ACC, mortality was higher in the non-surgical treatment group. (26.2% vs. 10.5%).Conclusions: mortality was higher in ACC patients treated with non-surgical treatment. ACME identifies high-risk patients. The validation to ACME could allow us to create a new alternative guideline to TG for treating ACC.Trial Registration: retrospectively registered and recorded in Clinical Trials (NTC 0474441).

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“…Postularon que la alta tasa de conversión hallada por otros autores en pacientes operados después de las primeras 72 horas, correspondía a un subgrupo con síntomas de más de una semana, debido a la dificultad en precisar el inicio de los síntomas en algunos de ellos, lo que ampliaba aún más el tiempo para practicar la colecistectomía por laparoscopia durante la fase aguda y la subaguda. En la Universidad de Toho en Tokyo, los resultados fueron similares en un análisis retrospectivo de 224 pacientes; en la colecistectomía por laparoscopia practicada después de 7 días de iniciados los síntomas, el tiempo quirúrgico y la estancia hospitalaria fueron más prolongados: 95 (30-295) Vs. 114 (20-242) minutos, y 5 (3-41) Vs. 9 (3-32) días, respectivamente 20 . En el presente estudio, se evaluó la seguridad de practicar la colecistectomía por laparoscopia en un grupo de pacientes con más de 72 horas de iniciados los síntomas.…”

Section: Discussionunclassified

“…Sin embargo, la media de tiempo quirúrgico fue de 99 minutos, siempre contando con la participación de un residente de cirugía general; este tiempo es un poco mayor al reportado en la revisión Cochrane 17 . Es de resaltar que, en los pacientes operados en los primeros 7 días, el tiempo quirúrgico fue mayor, tal como se encontró en estudios similares ya citados [19][20] . En 7 de los 184 pacientes, se practicó colecistectomía subtotal, similar a lo reportado en otros estudios (21) ; por lo tanto, se puede considerar una técnica segura en manos de cirujanos experimentados en técnicas mínimamente invasivas.…”

Section: Discussionunclassified

Colecistectomía por laparoscopia en colecistitis subaguda: análisis retrospectivo de pacientes en un hospital universitario

et al. 2018

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Evaluating the timing of laparoscopic cholecystectomy for acute cholecystitis in an experienced center based on propensity score matching

Abstract: Introduction: This study evaluates the therapeutic outcomes for laparoscopic

Cited by 8 publications

References 31 publications

Tokyo Guidelines 2018: management strategies for gallbladder drainage in patients with acute cholecystitis (with videos)

Tokyo Guidelines 2018: management strategies for gallbladder drainage in patients with acute cholecystitis (with videos)

Mortality Risk Estimation in Acute Calculous Cholecystitis: Beyond the Tokyo Guidelines

Colecistectomía por laparoscopia en colecistitis subaguda: análisis retrospectivo de pacientes en un hospital universitario

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