Authors: Mahdi Bouassida Hédi Charrada Bilel Feidi Mohamed Fadhel Chtourou Sélim Sassi Mohamed Mongi Mighri Fethi Chebbi Hassen Touinsi
Publish Date: 2015/06/21
Volume: 46, Issue: 5, Pages: 557-560
Abstract
The Tokyo guidelines for diagnostic criteria and severity assessment of acute cholecystitis AC published in 2007 recommend early laparoscopic cholecystectomy ELC be done as soon as possible after the onset of symptoms We conducted this study to analyze the changes in the therapeutic strategy for AC in a surgical center in Tunisia after the Tokyo guidelines were publishedBetween January 2005 and January 2013 649 patients underwent cholecystectomy for AC at the Department of Surgery Mohamed Tahar Maamouri Hospital in Nabeul Tunisia The study period was subdivided into before n = 192 and after n = 457 the publication of the Tokyo guidelines that is prior to and including 2007 and from 2008 onward respectively We reviewed patient records retrospectively to collect demographic data biochemical data radiological findings and postoperative outcomes All these factors were compared between the groupsThe duration of symptoms before surgery was significantly longer before 2008 p = 0018 ELC was significantly more frequent after 2008 p = 0001 Laparoscopic surgery was converted to open surgery in 161 of patients before 2008 vs 78 of patients after 2008 p = 002 There were no significant differences in bile duct injury or postoperative complications between the groups The length of preoperative postoperative and total hospital stay was longer before 2008ELC is a safe and effective therapeutic strategy for AC The Tokyo guidelines resulted in a significant increase in the number of ELCs being performed and significantly reduced preoperative and total hospital stay without increasing intra and postoperative complications Importantly ELC reduced medical costs which is crucial for a country with limited resources such as Tunisia
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