title: TG13 surgical management of acute cholecystitis.
abstract: BACKGROUND
  Laparoscopic cholecystectomy is now accepted as a surgical procedure for acute cholecystitis when it is performed by an expert surgeon. There are several lines of strong evidence, such as randomized controlled trials (RCTs) and meta-analyses, supporting the introduction of laparoscopic cholecystectomy for patients with acute cholecystitis. The updated Tokyo Guidelines 2013 (TG13) describe the surgical treatment for acute cholecystitis according to the grade of severity, the timing, and the procedure used for cholecystitis in a question-and-answer format using the evidence concerning surgical management of acute cholecystitis.
  
  
  METHODS
  Forty-eight publications were selected for a careful examination of their full texts, and the types of surgical management of acute cholecystitis were investigated using this evidence. The items concerning the surgical management of acute cholecystitis were the optimal surgical treatment for acute cholecystitis according to the grade of severity, optimal timing for the cholecystectomy, surgical procedure used for cholecystectomy, optimal timing of the conversion of cholecystectomy from laparoscopic to open surgery, and the complications of laparoscopic cholecystectomy.
  
  
  RESULTS
  There were eight RCTs and four meta-analyses concerning the optimal timing of the cholecystectomy. Consequently, it was found that cholecystectomy is preferable early after admission. There were three RCTs and two meta-analyses concerning the surgical procedure, which concluded that laparoscopic cholecystectomy is preferable to open procedures. Literature concerning the surgical treatment according to the grade of severity could not be quoted, because there have been no publications on this topic. Therefore, the treatment was determined based on the general opinions of professionals.
  
  
  CONCLUSIONS
  Surgical management of acute cholecystitis in the updated TG13 is fundamentally the same as in the Tokyo Guidelines 2007 (TG07), and the concept of a critical view of safety and the existence of extreme vasculobiliary injury are added in the text to call the surgeon's attention to the need to reduce the incidence of bile duct injury. Free full-text articles and a mobile application of TG13 are available via http://www.jshbps.jp/en/guideline/tg13.html.
authors.affiliation: Department of Gastroenterological Surgery, Fukuoka University Hospital, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan. yuichiya@fukuoka-u.ac.jp
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Takada
authors.forename: Steven M
authors.initials: SM
authors.lastname: Strasberg
authors.forename: Henry A
authors.initials: HA
authors.lastname: Pitt
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Gouma
authors.forename: O James
authors.initials: OJ
authors.lastname: Garden
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.forename: Harumi
authors.initials: H
authors.lastname: Gomi
authors.forename: Christos
authors.initials: C
authors.lastname: Dervenis
authors.forename: John A
authors.initials: JA
authors.lastname: Windsor
authors.forename: Sun-Whe
authors.initials: SW
authors.lastname: Kim
authors.forename: Eduardo
authors.initials: E
authors.lastname: de Santibanes
authors.forename: Robert
authors.initials: R
authors.lastname: Padbury
authors.forename: Xiao-Ping
authors.initials: XP
authors.lastname: Chen
authors.forename: Angus C W
authors.initials: AC
authors.lastname: Chan
authors.forename: Sheung-Tat
authors.initials: ST
authors.lastname: Fan
authors.forename: Palepu
authors.initials: P
authors.lastname: Jagannath
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Mayumi
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yoshida
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Miura
authors.forename: Toshio
authors.initials: T
authors.lastname: Tsuyuguchi
authors.forename: Takao
authors.initials: T
authors.lastname: Itoi
authors.forename: Avinash N
authors.initials: AN
authors.lastname: Supe
mesh_terms: D002763:Cholecystectomy; D017081:Cholecystectomy, Laparoscopic; D041881:Cholecystitis, Acute / Q000601:surgery*; D006801:Humans