Changing trends in surgical management for acute cholecystitis, in light of Tokyo guidelines - 14 year experience.
OBJECTIVE
To look for trends in surgical management of acute cholecystitis and compare the outcomes of patients with severe condition.


METHODS
The retrospective study was conducted at Aga Khan University Hospital, Karachi, from January to December 2016, and comprised data of adult patients who underwent cholecystectomy for acute cholecystitis from January 1, 2001, to December 31, 2014. Record of patients from 2001 to 2007 was designated in Group-1 while Group-II covered period between 2008 and 2014. Severe cases of acute cholecystitis were divided into similar period-based Group-A and Group-B. Data was analysed using SPSS 20.


RESULTS
Of the 1153 patients, 521(45.2%) were males. The overall mean age was 49.3+14 years. There were 309(36.2%) patents in Group-I and 844(73.2%) in Group-II. Early laparoscopic-cholecystectomy was performed in 907(78%) patients. Postoperative morbidity was observed in 73(6.3%) patients. In Group-II, there was significant increase in early cholecystectomy, decrease in conversion rates and use of percutaneous cholecystostomy tube placement (p<0.05 each). In patients with severe acute cholecystitis, higher rate of early cholecystectomy was found in Group-A but it was not significant, and the same was the case in terms of conversion rate, postoperative morbidity and hospital stay (p>0.05 each).


CONCLUSIONS
Over the years, the institutional experience of managing acute cholecystitis has changed dramatically which has helped improve the level of care for the patients.
['Pal|Inam|I|', 'Bhatti|Umar|U|', 'Bari|JHassan|J|']
D000328:Adult D017081:Cholecystectomy, Laparoscopic D041881:Cholecystitis, Acute D002767:Cholecystostomy D061887:Conversion to Open Surgery D019468:Disease Management D061345:Early Medical Intervention D005260:Female D006801:Humans D007902:Length of Stay D008297:Male D008875:Middle Aged D011183:Postoperative Complications D017410:Practice Guidelines as Topic D012189:Retrospective Studies
Laparoscopic cholecystectomy, Acute cholecystitis, Tokyo guidelines. (JPMA 69: 1505 2019).doi:10.5455/JPMA.1022