| International Session (Symposium) 3 (2) (JSGS・JSGE・JSH) |
| Fri. November 2nd 10:30 - 12:00 Room 9: Portopia Hotel Main Building Kairaku 3 |
| Treatment strategy for acute cholecystitis including safety of Lap-C | |||
| Kohji Okamoto1, Tadahiro Takada2 | |||
| 1Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, 2Department of Surgery, Teikyo University School of Medicine | |||
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| Acute cholecystitis (AC) is one of the most frequent abdominal emergencies. Flowcharts for the management of AC were presented in the Tokyo Guidelines 2007 (TG07) and the TG 2013 (TG13). We propose a new modified flowchart for the treatment of AC in the TG 2018 (TG18). The major changes are as follows. Grade III AC was not indicated for straightforward laparoscopic cholecystectomy (Lap-C) previously. 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. These are that the patients have favorable organ system failure, and negative predictive factors, who meet the criteria of Charlson Comorbidity Index (CCI) ≤ 3 and Society of Anesthesiologists Physical Status Classification (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. 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. For Grade I, TG18 recommends early Lap-C if the patients meet CCI ≤ 5 and ASA-PS ≤ 2. TG18 expand the indications for Lap-C under difficult conditions for each level of severity of AC. As a result of expanding the indications for Lap-C to treat AC, it is absolutely necessary to avoid any increase in bile duct injury (BDI), particularly vasculo-biliary injury (VBI), which is known to occur at a certain rate in Lap-C. To maintain the safety of Lap-C for AC, we also propose a new surgical management of AC in TG18. We would like to emphasize that it is a guideline created for patients suffering from acute cholangitis and acute cholecystitis. (1,991 characters) |
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Index Term 1: Tokyo Guidelines Index Term 2: Acute cholecystitis |
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