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

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  • Go Wakabayashi
    Department of Surgery Ageo Central General Hospital Saitama Japan
  • Yukio Iwashita
    Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan
  • Taizo Hibi
    Department of Surgery Keio University School of Medicine Tokyo Japan
  • Tadahiro Takada
    Department of Surgery Teikyo University School of Medicine Tokyo Japan
  • Steven M. Strasberg
    Section of Hepato‐Pancreato‐Biliary Surgery Washington University School of Medicine in St. Louis St. Louis MO USA
  • Horacio J. Asbun
    Department of Surgery Mayo Clinic College of Medicine Jacksonville FL USA
  • Itaru Endo
    Department of Gastroenterological Surgery Yokohama City University Graduate School of Medicine Kanagawa Japan
  • Akiko Umezawa
    Minimally Invasive Surgery Center Yotsuya Medical Cube Tokyo Japan
  • Koji Asai
    Department of Surgery Toho University Ohashi Medical Center Tokyo Japan
  • Kenji Suzuki
    Department of Surgery Fujinomiya City General Hospital Shizuoka Japan
  • Yasuhisa Mori
    Department of Surgery and Oncology Graduate School of Medical Sciences Kyushu University Fukuoka Japan
  • Kohji Okamoto
    Department of Surgery Center for Gastroenterology and Liver Disease Kitakyushu City Yahata Hospital Fukuoka Japan
  • Henry A. Pitt
    Lewis Katz School of Medicine at Temple University Philadelphia PA USA
  • Ho‐Seong Han
    Department of Surgery Seoul National University Bundang Hospital Seoul National University College of Medicine Seoul Korea
  • Tsann‐Long Hwang
    Division of General Surgery Linkou Chang Gung Memorial Hospital Taoyuan Taiwan
  • Yoo‐Seok Yoon
    Department of Surgery Seoul National University Bundang Hospital Seoul National University College of Medicine Seoul Korea
  • Dong‐Sup Yoon
    Department of Surgery Yonsei University Gangnam Severance Hospital Seoul Korea
  • In‐Seok Choi
    Department of Surgery Konyang University Hospital Daejeon Korea
  • Wayne Shih‐Wei Huang
    Department of Surgery Show Chwan Memorial Hospital Changhua Taiwan
  • Mariano Eduardo Giménez
    Chair of General Surgery and Minimal Invasive Surgery “Taquini” University of Buenos Aires DAICIM Foundation Buenos Aires Argentina
  • O. James Garden
    Clinical Surgery University of Edinburgh Edinburgh UK
  • Dirk J. Gouma
    Department of Surgery Academic Medical Center Amsterdam The Netherlands
  • Giulio Belli
    Department of General and HPB Surgery Loreto Nuovo Hospital Naples Italy
  • Christos Dervenis
    First Department of Surgery Agia Olga Hospital Athens Greece
  • Palepu Jagannath
    Department of Surgical Oncology Lilavati Hospital and Research Centre Mumbai India
  • Angus C. W. Chan
    Department of Surgery Surgery Centre Hong Kong Sanatorium and Hospital Hong Kong
  • Wan Yee Lau
    Faculty of Medicine The Chinese University of Hong Kong Shatin Hong Kong
  • Keng‐Hao Liu
    Division of General Surgery Linkou Chang Gung Memorial Hospital Taoyuan Taiwan
  • Cheng‐Hsi Su
    Department of Surgery Cheng Hsin General Hospital Taipei Taiwan
  • Takeyuki Misawa
    Department of Surgery The Jikei University Kashiwa Hospital Chiba Japan
  • Masafumi Nakamura
    Department of Surgery and Oncology Graduate School of Medical Sciences Kyushu University Fukuoka Japan
  • Akihiko Horiguchi
    Department of Gastroenterological Surgery Fujita Health University School of Medicine Aichi Japan
  • Nobumi Tagaya
    Department of Surgery Dokkyo Medical University Koshigaya Hospital Saitma Japan
  • Shuichi Fujioka
    Department of Surgery The Jikei University Kashiwa Hospital Chiba Japan
  • Ryota Higuchi
    Department of Surgery Institute of Gastroenterology Tokyo Women's Medical University Tokyo Japan
  • Satoru Shikata
    Director Mie Prefectural Ichishi Hospital Mie Japan
  • Yoshinori Noguchi
    Department of General Internal Medicine Japanese Red Cross Nagoya Daini Hospital Aichi Japan
  • Tomohiko Ukai
    Department of Family Medicine Mie Prefectural Ichishi Hospital Mie Japan
  • Masamichi Yokoe
    Department of General Internal Medicine Japanese Red Cross Nagoya Daini Hospital Aichi Japan
  • Daniel Cherqui
    Hepatobiliary Center Paul Brousse Hospital Villejuif France
  • Goro Honda
    Department of Surgery Tokyo Metropolitan Komagome Hospital Tokyo Japan
  • Atsushi Sugioka
    Department of Surgery Fujita Health University School of Medicine Aichi Japan
  • Eduardo de Santibañes
    Department of Surgery, Hospital Italiano University of Buenos Aires Buenos Aires Argentina
  • Avinash Nivritti Supe
    Department of Surgical Gastroenterology Seth G S Medical College and K E M Hospital Mumbai India
  • Hiromi Tokumura
    Department of Surgery Tohoku Rosai Hospital Miyagi Japan
  • Taizo Kimura
    Department of Surgery Fujinomiya City General Hospital Shizuoka Japan
  • Masahiro Yoshida
    Department of Hemodialysis and Surgery Ichikawa Hospital International University of Health and Welfare Chiba Japan
  • Toshihiko Mayumi
    Department of Emergency Medicine School of Medicine University of Occupational and Environmental Health Fukuoka Japan
  • Seigo Kitano
    President Oita University Oita Japan
  • Masafumi Inomata
    Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan
  • Koichi Hirata
    Department of Surgery JR Sapporo Hospital Hokkaido Japan
  • Yoshinobu Sumiyama
    Director Toho University Tokyo Japan
  • Kazuo Inui
    Department of Gastroenterology Second Teaching Hospital Fujita Health University Aichi Japan
  • Masakazu Yamamoto
    Director Mie Prefectural Ichishi Hospital Mie Japan

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説明

<jats:title>Abstract</jats:title><jats:p>In 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: <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="http://www.jshbps.jp/modules/en/index.php?content_id=47">http://www.jshbps.jp/modules/en/index.php?content_id=47</jats:ext-link>. Related clinical questions and references are also included.</jats:p>

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