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Comparative Study
. 2020 Mar;90(3):295-299.
doi: 10.1111/ans.15603. Epub 2019 Dec 17.

Acute cholecystitis or simple biliary colic after an emergency presentation: why it matters

Chu Luan Nguyen  1 , Aafke van Dijk  2 , Garett Smith  1   3 , Steven Leibman  1 , Anubhav Mittal  1   3 , Maria Albania  1 , Philip de Reuver  2 , Thomas J Hugh  1   3
Affiliations
Comparative Study

Acute cholecystitis or simple biliary colic after an emergency presentation: why it matters

Chu Luan Nguyen et al. ANZ J Surg. 2020 Mar.

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.

Keywords: Tokyo Guidelines; acute cholecystitis; laparoscopic cholecystectomy.

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References

    1. lrvin TT. Abdominal pain: a surgical audit of 1190 emergency admissions. Br. J. Surg. 1989; 76: 1121-5.
    1. Caporale N, Morselli-Labate AM, Nardi E, Cogliandro R, Cavazza M, Stanghellini V. Acute abdominal pain in the emergency department of a university hospital in Italy. United European Gastroenterol. J. 2016; 4: 297-304.
    1. Fitzgibbons RJJ, Tseng A, Wang H, Ryberg A, Nguyen N, Sims KL. Acute cholecystitis. Does the clinical diagnosis correlate with the pathological diagnosis? Surg. Endosc. 1996; 10: 1180-4.
    1. Hirota M, Takada T, Kawarada Y et al. Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines. J. Hepatobiliary Pancreat. Surg. 2007; 14: 78-82.
    1. Yokoe M, Hata J, Takada T et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J. Hepatobiliary Pancreat. Sci. 2018; 25: 41-54.

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