Tokyo Guidelines 2018: surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos)

Journal of Hepato-Biliary-Pancreatic Sciences - Tập 25 Số 1 - Trang 73-86 - 2018
Go Wakabayashi1, Yukio Iwashita2, Taizo Hibi3, Tadahiro Takada4, Steven M. Strasberg5, Horacio J. Asbun6, Itaru Endo7, Akiko Umezawa8, Koji Asai9, Kenji Suzuki10, Yasuhisa Mori11, Kohji Okamoto12, Henry A. Pitt13, Ho‐Seong Han14, Tsann‐Long Hwang15, Yoo‐Seok Yoon14, Dong Sup Yoon16, In‐Seok Choi17, Wayne Shih‐Wei Huang18, Mariano Giménez19, O. James Garden20, Dirk J. Gouma21, Giulio Belli22, Christos Dervenis23, Palepu Jagannath24, Annie On On Chan25, Wan Yee Lau26, Keng‐Hao Liu15, Cheng‐Hsi Su27, Takeyuki Misawa28, Masafumi Nakamura11, Akihiko Horiguchi29, Nobumi Tagaya30, Shozo Fujioka28, Ryota Higuchi31, Satoru Shikata32, Yoshinori Noguchi33, Tomohiko Ukai34, Masamichi Yokoe33, Daniel Cherqui35, Goro Honda36, Atsushi Sugioka37, Eduardo de Santibáñes38, Avinash Supe39, Hiromi Takeuchi40, Taizo Kimura10, Masahiro Yoshida41,42, Toshihiko Mayumi43, Seigo Kitano44, Masafumi Inomata2, Koichi Hirata45, Yoshinobu Sumiyama46, Kazuo Inui47, Masakazu Yamamoto32
1Department of Surgery, Ageo Central General Hospital, Saitama, Japan
2Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
3Department of Surgery, Keio University School of Medicine, Tokyo, Japan
4Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
5Section of Hepato-Pancreato-Biliary Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
6Department of Surgery, Mayo Clinic College of Medicine, Jacksonville, FL, USA
7Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
8Minimally Invasive Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
9Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
10Department of Surgery, Fujinomiya City General Hospital, Shizuoka, Japan
11Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
12Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Fukuoka, Japan
13Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
14Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
15Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
16Department of Surgery, Yonsei University Gangnam Severance Hospital, Seoul, Korea
17Department of Surgery, Konyang University Hospital, Daejeon, Korea
18Department of Surgery, Show Chwan Memorial Hospital, Changhua, Taiwan
19Chair of General Surgery and Minimal Invasive Surgery “Taquini” University of Buenos Aires DAICIM Foundation Buenos Aires Argentina
20Clinical Surgery, University of Edinburgh, Edinburgh, UK
21Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
22Department of General and HPB Surgery, Loreto Nuovo Hospital, Naples, Italy
23First Department of Surgery, Agia Olga Hospital, Athens, Greece
24Department of Surgical Oncology, Lilavati Hospital and Research Centre, Mumbai, India
25Department of Surgery, Surgery Centre, Hong Kong Sanatorium and Hospital, Hong Kong
26Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
27Department of Surgery, Cheng Hsin General Hospital, Taipei, Taiwan
28Department of Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan
29Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Aichi, Japan
30Department of Surgery, Dokkyo Medical University Koshigaya Hospital, Saitma, Japan
31Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan
32Director, Mie Prefectural Ichishi Hospital, Mie, Japan
33Department of General Internal Medicine, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan
34Department of Family Medicine, Mie Prefectural Ichishi Hospital, Mie, Japan
35Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France
36Department of Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
37Department of Surgery, Fujita Health University, School of Medicine, Aichi, Japan
38Department of Surgery, Hospital Italiano, University of Buenos Aires, Buenos Aires, Argentina
39Department of Surgical Gastroenterology, Seth G S Medical College and K E M Hospital, Mumbai, India
40Department of Surgery, Tohoku Rosai Hospital, Miyagi, Japan
41Department of EBM and Guidelines, Japan Council for Quality Health Care, Tokyo, Japan
42Department of Hemodialysis and Surgery, Ichikawa Hospital, International University of Health and Welfare, Chiba, Japan
43Department of Emergency Medicine, School of Medicine University of Occupational and Environmental Health, Fukuoka, Japan
44President, Oita University, Oita, Japan
45Department of Surgery, JR Sapporo Hospital, Hokkaido, Japan
46Director, Toho University, Tokyo, Japan
47Department of Gastroenterology, Second Teaching Hospital, Fujita Health University, Aichi, Japan

Tóm tắt

AbstractIn some cases, laparoscopic cholecystectomy (LC) may be difficult to perform in patients with acute cholecystitis (AC) with severe inflammation and fibrosis. The Tokyo Guidelines 2018 (TG18) expand the indications for LC under difficult conditions for each level of severity of AC. As a result of expanding the indications for LC to treat AC, it is absolutely necessary to avoid any increase in bile duct injury (BDI), particularly vasculo‐biliary injury (VBI), which is known to occur at a certain rate in LC. Since the Tokyo Guidelines 2013 (TG13), an attempt has been made to assess intraoperative findings as objective indicators of surgical difficulty; based on expert consensus on these difficulty indicators, bail‐out procedures (including conversion to open cholecystectomy) have been indicated for cases in which LC for AC is difficult to perform. A bail‐out procedure should be chosen if, when the Calot's triangle is appropriately retracted and used as a landmark, a critical view of safety (CVS) cannot be achieved because of the presence of nondissectable scarring or severe fibrosis. We propose standardized safe steps for LC to treat AC. To achieve a CVS, it is vital to dissect at a location above (on the ventral side of) the imaginary line connecting the base of the left medial section (Segment 4) and the roof of Rouvière's sulcus and to fulfill the three criteria of CVS before dividing any structures. Achieving a CVS prevents the misidentification of the cystic duct and the common bile duct, which are most commonly confused. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.

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Journal of Hepato-Biliary-Pancreatic Sciences

Tập 25 Số 1

73-86

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