Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis

We propose a new flowchart for the treatment of acute cholecystitis (AC) in the Tokyo Guidelines 2018 (TG18). Grade III AC was not indicated for straightforward laparoscopic cholecystectomy (Lap-C). Following analysis of subsequent clinical investigations and drawing on Big Data in particular, TG18 proposes that some Grade III AC can be treated by Lap-C when performed at advanced centers with specialized surgeons experienced in this procedure and for patients that satisfy certain strict criteria. For Grade I, TG18 recommends early Lap-C if the patients meet the criteria of Charlson comorbidity index (CCI) ≤5 and American Society of Anesthesiologists physical status classification (ASA-PS) ≤2. For Grade II AC,…

• UO
  University of Pittsburgh
• TU
  Temple University
• TU
  Teikyo University School of Medicine
• SN
  Seoul National University Bundang Hospital
• KU
  Keio University
• SN
  Seoul National University
• CG
  Chang Gung Medical Foundation
• WU
  Washington University School of Medicine in St. Louis
• CO
  College of Medicine, Seoul National University