Acute cholecystitis or simple biliary colic after an emergency presentation: why it matters

Area of Science:

• Gastroenterology
• Surgical Innovation
• Clinical Diagnostics

Background:

• Laparoscopic cholecystectomy (LC) is frequently performed during initial hospital admission for acute biliary pain.
• Acute cholecystitis (AC) can complicate LC, increasing operative difficulty and potential complications.
• Accurate diagnosis of AC is crucial for patient management and surgical planning.

Purpose of the Study:

• To evaluate the diagnostic accuracy of the Tokyo Guidelines 2018 (TG18) for AC.
• To compare TG18 AC diagnosis with admitting surgical team diagnosis, operative findings, and histopathology.
• To assess patient outcomes following same-admission versus delayed LC for AC.

Main Methods:

• Retrospective analysis of 139 patients undergoing LC over 12 months at a tertiary hospital.
• Comparison of diagnostic criteria (TG18, surgical team) against operative findings and histopathology.
• Analysis of outcomes, including complications, conversion rates, and length of stay, for same-admission versus delayed LC.

Main Results:

• No mortality or bile duct injuries were observed.
• Admitting surgical team diagnosis of AC had 84% sensitivity and 57% specificity; TG18 had 84% sensitivity and 53% specificity.
• Poor correlation existed between clinical and histopathological diagnoses; AC patients experienced longer hospital stays and more complications.
• Same-admission LC and delayed LC showed similar patient outcomes.

Conclusions:

• TG18 diagnostic criteria for AC do not offer improved accuracy or outcome prediction compared to admitting surgical team diagnosis.
• Same-admission LC for AC is a safe and effective approach with outcomes comparable to delayed LC.