Severity Grading and Management Stratification of Acute Calculus Cholecystitis with Reference to Tokyo Guideline - A Prospective Analytical Study in Tertiary Care Centre

Abstract

INTRODUCTION: Major causes of acute abdomen in the outpatient department of hospitals worldwide is an acute inflammation of the gallbladder. Acute calculus cholecystitis is defined as acute inflammation of the gallbladder, commonly caused by gallstones impacted in the cystic duct and usually associated with abdominal pain ,vomiting, and fever.^1,2 Gallstones affect between 10% and 15% of the population, and of those, 1% to 4% will develop symptoms annually.³

Tokyo guidelines were proposed for the diagnosis, severity assessment, and management recommendations of acute cholecystitis.it was published in 2006,and was revised in 2013&2018.

Aims: To grade the severity of acute calculus cholecystitis and stratify the management and outcome with reference to TOKYO guidelines.

Materials and Methods: This was prospective analytical study; it was carried out on 100 patients diagnosed case of acute calculus cholecystitis admitted in the General Surgery Department at Jorhat medical college and hospital in the period from january 2023 to december 2023.

Results: The present study showed that majority of the patients presented <72 hours of symptoms (56%)and the most common symptom in acute cholecystitis was pain abdomen and the most common sign was tenderness over right hypochondrium.Female predominance was seen with a ratio of 1.2:1. Duration of surgery increased with severity grade. Grade I (69.66±15.80)mins and grade II (84.11±15.87)mins. Postoperative complications were fewer in Grade I (3.3%) as compared to Grade II (8.8%). Hospital stay increased with severity and patients of Grade III managed conservatively had the longest hospital stay.

Conclusion: Tokyo Guidelines allows early diagnosis and easy categorization of patients into various grades and also to determine the necessity for early cholecystectomy in case of acute cholecystitis based on the different grades defined by the guidelines. To reduce the sequelae of acute cholecystitis, Tokyo Guidelines can be followed.