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Utility of Tokyo guidelines and intraoperative safety steps in improving the outcome of laparoscopic cholecystectomy in complex acute calculus cholecystitis: a prospective study
- Source :
- Surgical endoscopy. 35(8)
- Publication Year :
- 2020
-
Abstract
- Laparoscopic cholecystectomy (LC) in complicated acute calculus cholecystitis (ACC) poses multiple challenges. This prospective, observational study assessed the utility and safety of a set protocol and intraoperative steps in LC for complex ACC. All cases of ACC from 2008 to 2018 were graded as per Tokyo guidelines; moderate and severe ACC were termed as ‘complex ACC (CACC).’ Patients were subjected to upfront LC or percutaneous drainage (PCD) followed by LC. Seven intraoperative safety steps were used to achieve critical view of safety (CVS). Use of safety steps, duration of surgery, and length of hospital stay were compared between moderate and severe ACC; complications were classified using Clavien–Dindo classification. We analyzed 145 patients with moderate (74.5%) and severe (25.5%) ACC. There were significantly more male (p = 0.0059) and older (p = 0.0006) patients with severe ACC. Upfront LC was performed in 81.4%; PCD required in 6.9%. Timing of LC from symptom onset was
- Subjects :
- Male
medicine.medical_specialty
Percutaneous
Cholecystitis, Acute
Calculi
03 medical and health sciences
0302 clinical medicine
Postoperative Complications
Internal medicine
medicine
Calculus
Humans
Prospective Studies
Prospective cohort study
Tokyo
Laparoscopic cholecystectomy
Grade IIIa
business.industry
Bile duct
Hepatology
Length of Stay
medicine.disease
medicine.anatomical_structure
Treatment Outcome
nervous system
Cholecystectomy, Laparoscopic
030220 oncology & carcinogenesis
Cholecystitis
030211 gastroenterology & hepatology
Surgery
business
Abdominal surgery
Subjects
Details
- ISSN :
- 14322218
- Volume :
- 35
- Issue :
- 8
- Database :
- OpenAIRE
- Journal :
- Surgical endoscopy
- Accession number :
- edsair.doi.dedup.....6bdfb34e695d4c3b4fb1cc0866c2f0b1