Tokyo Guidelines 2013 may be too restrictive and patients with moderate and severe acute cholecystitis can be managed by early cholecystectomy too

Amirthalingam, Vinoban; Low, Jee Keem; Woon, Winston; Shelat, Vishal G

doi:10.1007/s00464-016-5300-4

Cited by 64 publications

(50 citation statements)

References 28 publications

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“…of 149 patients, the authors similarly found that although severity grade was significantly associated with mean length of stay, it was not associated with either complications. From those results, they mentioned severity grading of AC was not the sole determinant of early LC . They also mentioned that AC patients with Grade III, who had not been admitted to the ICU can be regarded as suitable candidates for early LC.…”

Section: Discussionmentioning

confidence: 99%

“…On the question of Grade III, two Australian and Singaporean studies have suggested that even Grade III patients can safely undergo surgery . Kamalapurkar et al.…”

Section: Discussionmentioning

confidence: 99%

“…The TG13 severity grading criteria have been criticized by the opinion that indicating operative difficulty was insufficient . Borzellino et al.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Grade I (mild) comprises cases other than Grades II and III, with lower risk of death and surgical risk that can easily be treated by laparoscopic cholecystectomy (LC). Since the Tokyo Guidelines (TG) have ORIGINAL ARTICLE become widely known worldwide, recent multidirectional studies have evaluated the TG13 severity grading criteria for AC [2][3][4][5][6][7][8][9][10][11][12]. In Tunisia, the spread of the TG has increased the rate of LC, significantly reducing preoperative and total hospital stay without increasing intra-and postoperative complications [2]; in Taiwan, Cheng et al mentioned the complication rate and the length of hospital stay increased along with the severity grade of the TG [3]; and in Japan, too, a significant correlation has been reported between severity grade and both prolonged postoperative hospital stay and medical cost [4].…”

Section: Introductionmentioning

confidence: 99%

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Validation of TG13 severity grading in acute cholecystitis: Japan‐Taiwan collaborative study for acute cholecystitis

Yokoe

Takada

Hwang

et al. 2017

J Hepato Biliary Pancreat

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Background The collaborative multicenter retrospective study of acute cholecystitis (AC) was performed in Japan and Taiwan. The aim for this study was evaluation of the clinical value of TG13 severity grading for AC. Method The study was designed as an international multicenter retrospective study of AC from 2011 to 2013. Based on the data, we investigated the TG13 severity grading by analyzing the correlations between grade and prognosis, surgical procedures, histopathology, and organ dysfunction and prognosis. Results An investigation revealed that 30-day overall mortality rate was 1.1% for Grade I, 0.8% for Grade II, 5.4% for Grade III. The mortality rate for Grade III was significantly higher than lower grades (P < 0.001). The greater the number of organ dysfunction, the higher the mortality rate (P < 0.001). However, the mortality rate varied depending on the number of organ dysfunction (3.1-25%). With respect to the surgical procedures, laparoscopic cholecystectomy was performed for Grade I patients (P < 0.001), and the higher the grade, the more likely open surgery would be selected (P < 0.001). Conclusion TG13 severity grading criteria for AC are providing great benefits in actual clinical settings. From this study, the position of each severity grade was obviously confirmed.

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Section: Discussionmentioning

confidence: 99%

“…On the question of Grade III, two Australian and Singaporean studies have suggested that even Grade III patients can safely undergo surgery . Kamalapurkar et al.…”

Section: Discussionmentioning

confidence: 99%

“…The TG13 severity grading criteria have been criticized by the opinion that indicating operative difficulty was insufficient . Borzellino et al.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Validation of TG13 severity grading in acute cholecystitis: Japan‐Taiwan collaborative study for acute cholecystitis

Yokoe

Takada

Hwang

et al. 2017

J Hepato Biliary Pancreat

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Adhesive small bowel obstruction – an update

Tong

Lingam

Shelat

2020

Acute Medicine & Surgery

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Small bowel obstruction (SBO) accounts for 12–16% of emergency surgical admissions and 20% of emergency surgical procedures. Even with the advent of laparoscopic surgery, intra‐abdominal adhesions remain a significant cause of SBO, accounting for 65% of cases. History and physical examination are essential to identify signs of bowel ischemia as this indicates a need for urgent surgical exploration. Another critical aspect of evaluation includes establishing the underlying cause for obstruction and distinguishing between adhesive and non‐adhesive etiologies as adhesive SBO (ASBO) can be managed non‐operatively in 70–90% of patients. A patient with a history of abdominopelvic surgery along with one or more cardinal features of obstruction should be suspected to have ASBO until proven otherwise. Triad of severe pain, pain out of proportion to the clinical findings, and presence of an abdominal scar suggest possible closed‐loop obstruction. Computed tomography has higher sensitivity and specificity compared to plain films and is recommended by the Bologna guidelines. Correcting fluid and electrolyte imbalance is an initial crucial step to mitigate severe hypovolemia. Patients should proceed with surgery if symptoms of bowel compromise are present, or if symptoms do not resolve or have worsened. Surgery is indicated in patients with ischemia, strangulation, perforation, peritonitis, or failure of non‐operative treatment. With advances in minimal access technology and increasing experience, laparoscopic adhesiolysis is recommended. Mechanical adhesion barriers are an effective measure to prevent adhesion formation.

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Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos)

Yokoe

Hata

Takada

et al. 2018

J Hepato Biliary Pancreat

890

605

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The Tokyo Guidelines 2013 (TG13) for acute cholangitis and cholecystitis were globally disseminated and various clinical studies about the management of acute cholecystitis were reported by many researchers and clinicians from all over the world. The 1 st edition of the Tokyo Guidelines 2007 (TG07) was revised in 2013. According to that revision, the TG13 diagnostic criteria of acute cholecystitis provided better specificity and higher diagnostic accuracy. Thorough our literature search about diagnostic criteria for acute cholecystitis, new and strong evidence that had been released from 2013 to 2017 was not found with serious and important issues about using TG13 diagnostic criteria of acute cholecystitis. On the other hand, the TG13 severity grading for acute cholecystitis has been validated in numerous studies. As a result of these reviews, the TG13 severity grading for acute cholecystitis was significantly associated with parameters including 30-day overall mortality, length of hospital stay, conversion rates to open surgery, and medical costs. In terms of severity assessment, breakthrough and intensive literature for revising severity grading was not reported. Consequently, TG13 diagnostic criteria and severity grading were judged from numerous validation studies as useful indicators in clinical practice and adopted as TG18/TG13 diagnostic criteria and severity grading of acute cholecystitis without any modification. 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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Tokyo Guidelines 2013 may be too restrictive and patients with moderate and severe acute cholecystitis can be managed by early cholecystectomy too

Abstract: Severity grading of AC is not the sole determinant of early LC. Patient comorbidity also impacts clinical decision. Confirmation in a larger cohort is warranted.

Cited by 64 publications

References 28 publications

Validation of TG13 severity grading in acute cholecystitis: Japan‐Taiwan collaborative study for acute cholecystitis

Validation of TG13 severity grading in acute cholecystitis: Japan‐Taiwan collaborative study for acute cholecystitis

Adhesive small bowel obstruction – an update

Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos)

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