Abstract

CLINICAL OUTCOME OF MANAGEMENT OF ACUTE CHOLECYSTITIS FOLLOWING TOKYO GUIDELINES

Dr. Purujit Choudhury* and Dr. Anisha Singha

ABSTRACT

Background: Acute cholecystitis is one of major causes of acute abdomen worldwide. It was once considered a contraindication for cholecystititis. However, the Tokyo Guidelines were established to determine timing of surgery for acute cholecystitis depending on the severity, showing a clear benefit in performing early rather than delayed cholecystectomy. The aim of the study is to categorize the patients of acute cholecystitis into various grades according to Tokyo Guidelines and outcome of management following the guidelines. Materials And Methods: A prospective study of 100 patients with acute cholecystitis was carried out over a period of 15 months in the Department of General Surgery, Gauhati Medical College. Diagnosis of acute calculus cholecystitis was made based on the clinical examination, laboratory investigations and ultrasonography. The severity and management were based on the Tokyo Guidelines. The outcome were measured with respect to conversion rate, length of hospital stay and postoperative complications. Results: The mean age was 47.9±13.3 years with a female preponderance. Most common presenting symptom was pain with majority of the patients presenting within 72 hours. Pain abdomen was seen in 86 patients, however, right hypochondriac/ epigastric tenderness was elicited in 90 patients. Thickening of gallbladder was the most common ultrasonographic finding (n=66). All patients of Grade I (n=32) and II (n=66) underwent surgery and majority of them were operated after 72 hours but within 7 days (n=73). For all patients the length of hospital stay was found to increase with severity (Grade I vs II vs III = 6 vs 9 vs 13 days). For surgical patients (n=98), the conversion rates (p=0.085), duration of surgery (p<0.001) and number of post-operative complications (5 vs 1) were found to increase with increasing TG13 grade. Conclusions: Tokyo guidelines allows early diagnosis and categorization of patients into various grades. The clinical outcome of patients when managed according to the guidelines produced desirable results in acute cholecystitis.

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