Acute cholecystitis or simple biliary colic after an emergency presentation: why it matters. Issue 3 (17th December 2019)

• Record Type: Journal Article
• Authors: Nguyen, Chu Luan; van Dijk, Aafke; Smith, Garett; Leibman, Steven; Mittal, Anubhav; Albania, Maria; de Reuver, Philip; Hugh, Thomas J.
• Is Part Of: ANZ journal of surgery. Volume 90:Issue 3(2020)
• Page Start: 295
• Page End: 299
• Publication Date: 2019-12-17
• Subjects: acute cholecystitis -- Tokyo Guidelines -- laparoscopic cholecystectomy; Surgery -- Periodicals; 617.005
• DOI: 10.1111/ans.15603
• Languages: English
• ISSNs: 1445-1433

Abstract

Abstract: Background: Laparoscopic cholecystectomy (LC) is often performed during the index admission after emergency presentation for acute biliary pain. Many patients have acute cholecystitis (AC) that may increase operative difficulty and complications. Our primary aim was to assess the validity of Tokyo Guidelines (TG18) for diagnosing AC by comparison with the admitting team diagnosis, operative findings and histopathology. The secondary aim was to assess outcomes after same‐admission or delayed LC. Methods: Retrospective analysis of patients who underwent LC after presenting to a tertiary hospital emergency department over a 12‐month period was conducted. Results: A total of 139 patients underwent LC with no mortality or bile duct injury. A diagnosis of AC made by the admitting surgical team had sensitivity of 84% and specificity of 57%. The TG18 diagnosis had sensitivity of 84% and specificity of 53%. A diagnosis of AC by the admitting surgical team correlated well with TG18 criteria diagnosis. There was poor correlation between clinical and histopathological diagnoses. Nine percent of patients had complications and 4% required conversion to open procedure. Patients with a clinical diagnosis of AC had longer post‐operative length of stay and more complications compared with those who had non‐AC diagnosis. There was no difference in outcomes between same‐admission LC or delayed LC. Conclusion: TG18 diagnosis of AC does not improve accuracy of diagnosis or predictability of a poor outcome over the admitting surgical team diagnosis. Same‐admission LC for patients with AC is associated with similar outcomes compared to those who undergo delayed LC. Abstract : Tokyo Guidelines diagnosis of acute cholecystitis does not improve accuracy of diagnosis or predictability of a poor outcome over admitting surgical team diagnosis. Same‐admission laparoscopic cholecystectomy for patients with acute cholecystitis is associated with similar outcomes compared to those who undergo delayed laparoscopic cholecystectomy.