title: Index cholecystectomy in grade II and III acute calculous cholecystitis is feasible and safe.
abstract: BACKGROUND
  According to the Tokyo Guidelines, recommendation on management of moderate and severe cholecystitis are cholecystostomy in severe cases and either cholecystostomy or emergency cholecystectomy in moderate cases depending on surgical experience. The rationale for this is that percutaneous cholecystostomy is a short procedure while laparoscopic cholecystectomy may be associated with a larger physiological insult. The aim of this study was to determine the safety and efficacy of cholecystectomy in moderate and severe acute calculous cholecystitis (ACC) at our institution.
  
  
  METHODS
  A retrospective review of patients presenting to Westmead Hospital with ACC between 2011 and 2012 was performed. Patients were classified according to the Tokyo Guidelines and only grade II and grade III patients were included. Clinical and complication details were recorded from the clinical notes.
  
  
  RESULTS
  Of the 84 patients, 60 had grade II and 24 had grade III ACC. The mean age was 52 years and 59% were female. In both groups, index cholecystectomy was performed in 88% of patients. None of the grade II ACC patients and three (12%) of grade III ACC underwent cholecystostomy. Length of stay (5 versus 12, P < 0.001) and conversion rate (2% versus 27%, P = 0.006) was higher in the grade III group. There were no deaths in patient who underwent surgery in either group. Severe complications were not significantly different (2% versus 9%, P = 0.219).
  
  
  CONCLUSIONS
  Index cholecystectomy is feasible with low morbidity and no mortality even in severe ACC. Emergency cholecystectomy in the setting of severe cholecystitis appear to be safe and technically feasible option.
authors: Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.
authors: Deepali
authors: D
authors: Kamalapurkar
authors: Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.|Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors: Tony C Y
authors: TC
authors: Pang
authors: Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.
authors: Mehan
authors: M
authors: Siriwardhane
authors: Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.|Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors: Michael
authors: M
authors: Hollands
authors: Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.|Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors: Emma
authors: E
authors: Johnston
authors: Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.|Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors: Henry
authors: H
authors: Pleass
authors: Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.|Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors: Arthur
authors: A
authors: Richardson
authors: Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.|Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors: Vincent W T
authors: VW
authors: Lam
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic; D041881:Cholecystitis, Acute / Q000175:diagnosis / Q000601:surgery*; D002767:Cholecystostomy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
keywords: Tokyo Guidelines; acute calculous cholecystitis; gall bladder drainage; index laparoscopic cholecystectomy; percutaneous cholecystostomy