title: Changes in the therapeutic strategy for acute cholecystitis after the Tokyo guidelines were published.
abstract: BACKGROUND
  This study examined the feasibility of early laparoscopic cholecystectomy (ELC) for acute cholecystitis (AC) according to the Tokyo guidelines severity grade, and analyzed the changes in the therapeutic strategy for AC after the Tokyo guidelines were published.
  
  
  METHODS
  A total of 225 patients were enrolled in this study. The therapeutic period was divided into two periods: before and after the publication of the Tokyo guidelines (prior to and including 2007, and from 2008, respectively).
  
  
  RESULTS
  Comparing the surgical strategy between ELC and delayed laparoscopic cholecystectomy (DLC), significant differences were found in the length of preoperative hospital stay and total hospital stay for cases of mild AC compared with moderate AC. With conversion to open surgery, postoperative complications including postoperative bile leak were not significantly different. Since ELC was performed significantly more often after publication of the guidelines, preoperative, postoperative, and total hospital stays were significantly shorter in the later period.
  
  
  CONCLUSIONS
  ELC is a safe and effective therapeutic strategy for both mild and moderate AC. The Tokyo guidelines resulted in a significant increase in the performance of ELC and significantly reduced preoperative and total hospital stays without increasing intra- and postoperative complications.
authors.affiliation: Department of Surgery, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan. k-asai@mvg.biglobe.ne.jp
authors.forename: Koji
authors.initials: K
authors.lastname: Asai
authors.forename: Manabu
authors.initials: M
authors.lastname: Watanabe
authors.forename: Shinya
authors.initials: S
authors.lastname: Kusachi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Matsukiyo
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Saito
authors.forename: Hajime
authors.initials: H
authors.lastname: Kodama
authors.forename: Kojiro
authors.initials: K
authors.lastname: Dotai
authors.forename: Osahiko
authors.initials: O
authors.lastname: Hagiwara
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Enomoto
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Okamoto
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Saida
authors.forename: Jiro
authors.initials: J
authors.lastname: Nagao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D041881:Cholecystitis, Acute / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome