Document Detail

Impact of the Tokyo guidelines on the management of patients with acute calculous cholecystitis.
MedLine Citation:
PMID:  19686411     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND AIM: Prompt treatments for acute calculous cholecystitis can reduce both mortality and morbidity. The aim of this retrospective study was to assess the impact of the Tokyo guidelines on management of patients with acute cholecystitis. METHODS: The records of patients admitted due to acute calculous cholecystitis were collected between January 2007 and June 2008. Exclusion criteria included acalculous, hepatobiliary malignancy, younger than 18 years old and mortality unrelated to cholecystitis. These 235 patients were classified into three groups; grade I, grade II and grade III, according to the severity grading in the Tokyo guidelines for acute cholecystitis. They were further classified into two subgroups; those compatible with and incompatible with managements suggested in the Tokyo guidelines, for comparison. RESULTS: Lower levels of platelets, lower blood pressure, higher levels of C-reactive protein, blood urine nitrogen, prothrombin time, bilirubin, alkaline phosphatase, and more incidences of positive microorganisms cultured in bile or blood, were found in patients as the severity of disease progressed. Shorter mean length of hospital stay was compatible with the Tokyo guidelines, but no significant differences in outcomes, including incidences of survival, post-surgery complications and mortality, were found between the two subgroups. CONCLUSION: No significant benefit of the application of the Tokyo guidelines in the management of patients was found between the two subgroups except for reduced mean length of hospital stay. The application of the Tokyo guidelines for improving the outcomes of patients with acute cholecystitis needs further investigation and evaluation.
Shou-Wu Lee; Sheng-Shun Yang; Chi-Sen Chang; Hong-Jeh Yeh
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of gastroenterology and hepatology     Volume:  24     ISSN:  1440-1746     ISO Abbreviation:  J. Gastroenterol. Hepatol.     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-12-16     Completed Date:  2010-03-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8607909     Medline TA:  J Gastroenterol Hepatol     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  1857-61     Citation Subset:  IM    
Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
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MeSH Terms
Aged, 80 and over
Anti-Bacterial Agents / therapeutic use*
Cholecystectomy, Laparoscopic*
Cholecystitis, Acute / diagnosis,  etiology,  mortality,  therapy*
Gallstones / complications,  diagnosis,  mortality,  therapy*
Guideline Adherence
Length of Stay
Middle Aged
Patient Selection*
Practice Guidelines as Topic
Retrospective Studies
Severity of Illness Index
Taiwan / epidemiology
Treatment Outcome
Reg. No./Substance:
0/Anti-Bacterial Agents
Comment In:
J Gastroenterol Hepatol. 2009 Dec;24(12):1806-7   [PMID:  20002938 ]

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