Lithiasic acute cholecystitis: application of Tokyo Guidelines in severity grading

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Background: Acute calculous cholecystitis (AC) is one of the most frequent surgical emergencies in our field.Laparoscopic cholecystectomy is considered the treatment of choice, although not sufficiently widespread.Objective: To analyze the application of the Tokyo Guidelines in the management of AC and to determine the influence of the degree of severity on management and prognosis.Method: Prospective, observational study of patients with a primary diagnosis of AC between 2010 and 2015.Exclusion criteria: AC recurrence; AC as a secondary diagnosis; acalculous cholecystitis; concurrent biliary pathology.Severity was classified according to Tokyo 2013 Guidelines.Results: 998 patients were included: 338 (33.9%) mild AC, 567 (56.8%) moderate AC, and 93 (9.3%) severe AC.A total of 582 (58.3%) patients were operated on.Postoperative complications Dindo-Clavien grade ≥ II 12.6%: mild AC 3.6%; moderate AC 12.2%; severe AC 49.0% (p < 0.001).Overall mortality 2%: mild AC 0%; moderate AC 0.5%; severe AC 18.0% (p < 0.001).Conclusion: Urgent laparoscopic cholecystectomy remains the treatment of choice for mild and moderate AC.In patients with severe AC, the risks and benefits of surgery should be assessed, given the high degree of complications and associated mortality.

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