Surgical treatment of patients with acute cholecystitis: Tokyo Guidelines.
Cholecystectomy has been widely performed in the treatment of acute cholecystitis, and laparoscopic cholecystectomy has been increasingly adopted as the method of surgery over the past 15 years. Despite the success of laparoscopic cholecystectomy as an elective treatment for symptomatic gallstones, acute cholecystitis was initially considered a contraindication for laparoscopic cholecystectomy. The reasons for it being considered a contraindication were the technical difficulty of performing it in acute cholecystitis and the development of complications, including bile duct injury, bowel injury, and hepatic injury. However, laparoscopic cholecystectomy is now accepted as being safe for acute cholecystitis, when surgeons who are expert at the laparoscopic technique perform it. Laparoscopic cholecystectomy has been found to be superior to open cholecystectomy as a treatment for acute cholecystitis because of a lower incidence of complications, shorter length of postoperative hospital stay, quicker recuperation, and earlier return to work. However, laparoscopic cholecystectomy for acute cholecystitis has not become routine, because the timing and approach to the surgical management in patients with acute cholecystitis is still a matter of controversy. These Guidelines describe the timing of and the optimal surgical treatment of acute cholecystitis in a question-and-answer format.
Yamashita
Yuichi
Y
Department of Surgery, Fukuoka University Hospital, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
Takada
Tadahiro
T
Kawarada
Yoshifumi
Y
Nimura
Yuji
Y
Hirota
Masahiko
M
Miura
Fumihiko
F
Mayumi
Toshihiko
T
Yoshida
Masahiro
M
Strasberg
Steven
S
Pitt
Henry A
HA
de Santibanes
Eduardo
E
Belghiti
Jacques
J
Büchler
Markus W
MW
Gouma
Dirk J
DJ
Fan
Sheung-Tat
ST
Hilvano
Serafin C
SC
Lau
Joseph W Y
JW
Kim
Sun-Whe
SW
Belli
Giulio
G
Windsor
John A
JA
Liau
Kui-Hin
KH
Sachakul
Vibul
V
D001652:Bile Ducts / Q000293:injuries; D002763:Cholecystectomy; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D041881:Cholecystitis, Acute / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications; D016032:Randomized Controlled Trials as Topic; D014041:Tokyo; D016896:Treatment Outcome