Does the Tokyo guidelines predict the extent of gallbladder inflammation in patients with acute cholecystitis? A single center retrospective analysis

BMC Gastroenterology

Dirk Wassenberg¹  Hildegard Christ³  Peter C. Ambe² 

[1] Department of General, Visceral and Thoracic Surgery, St. Remigius Hospital Opladen, An St. Remigius 26, Leverkusen, 51379, Germany;Helios Klinikum Wuppertal, Department of Surgery II, Witten – Herdecke University, Heusner Str. 40, Wuppertal, 42283, Germany;Department of Medical Statistics and Epidemiology, University of Cologne, Germany, Kerpener Str. 62, Köln, 50937, Germany

关键词: Necrotizing cholecystitis;    Gangrenous cholecystitis;    Gallbladder inflammation;    Tokyo guidelines;    Laparoscopic cholecystectomy;    Acute cholecystitis;   

Others  :  1234335
DOI  :  10.1186/s12876-015-0365-4

 received in 2015-04-21, accepted in 2015-10-03,  发布年份 2015

【 摘 要 】

Background

The Tokyo guidelines provide criteria for the diagnosis and classification of acute cholecystitis in three severity grades. However, no data exists on the predictive value of these guidelines. The aim of this study was to analyze the accuracy of the Tokyo guidelines as a predicting parameter for the severity of acute cholecystitis in patients undergoing laparoscopic cholecystectomy.

Methods

A retrospective analysis of the charts of patients undergoing laparoscopic cholecystectomy for acute cholecystitis in a primary care hospital within a five-year period was performed. The preoperative severity grades were compared with the histological extent of inflammation.

Results

One hundred thirty-eight patients; 79 with severity grade I, 33 with grade II and 26 with grade III were analyzed. The incidence of uncomplicated cholecystitis decreased with increasing severity grade, while the incidence of complicated cholecystitis increased with increasing severity. However, complicated cholecystitis was evident in an unexpectedly high number of cases with severity grade I. There was a significant correlation (χ² (1) = 10. 43, p = 0.01) between the preoperative severity grade and the extent of gallbladder inflammation on histopathology. Conversion to open surgery (14 vs. 5, p = 0.002) and complications (17 vs. 7, p = 0.001) were significantly higher in patients with preoperative severity grade II/III compared to patients with severity grade I.

Conclusion

Worsening clinical severity correlated significantly with worseing pathology, findings from blood test and clinical outcomes; rates of conversion and morbidity. However, the Tokyo guidelines may have a tendency to underestimate the extent of inflammation in male patients with severity grade I and over estimate the difficulty of dissection in severity grade II.

【 授权许可】

   
2015 Ambe et al.

【 图 表 】

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