Early versus Delayed Laparoscopic Cholecystectomy in Acute Calcular Cholecystitis According to Tokyo Guidelines: A Prospective Study

Abstract
Background: Acute Cholecystitis (AC) is acute inflam-mation of the gallbladder wall associated with leukocytosis and fever and is the second most common cause of inflamma-tory acute abdomen. The Tokyo Guidelines 2013 (TG13) was started as a way to show recommended diagnosis and treat-ments according to the severity of AC. Patients are classified into Grade I (mild) acute cholecystitis in a healthy patient with no organ dysfunction, Grade II (moderate) acute chole-cystitis is associated with (Elevated WBC count >18,000/mm3, mass in the right upper abdominal quadrant, duration of complaints >72 hours, Grade III (severe) acute cholecystitis is associated with organ dysfunction.
Aim of Work: The aim of the work was to study TG13 in diagnosis and severity of acute cholecystitis.
Patients and Methods: This analytical prospective study was carried out on 50 patients presented with acute calcular cholecystitis admitted in the General Surgery Department at Al-Zahraa University Hospital in the period from April 2016 to November 2017 with assesmment and treatment according to TG13 either early or laparoscopic cholecystectomy.
Results: Statistical analysis of our study showed accuracy with TG13 and other studies done according to it with low conversion rate from laparoscopic to open surgery and low intraoperative and post-operative complications.
Conclusions: It is important to use Tokyo guidelines during diagnosis and treatment of acute calcular cholecystitis.