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Acute Cholecystitis Classification. Analysis and Evaluation of the New Diagnostic Criteria and Severity of Acute Cholecystitis Revised By Tokyo Group 2013 Raul Gaxiola1, SANDRA LUZ BRIONES-FRAGA*2, Norma Eleane Basurto-Acevedo1, ARTURO REDING-BERNAL1, Jorge L. De-Leon1 1GENERAL SURGERY, HOSPITAL GENERAL DE MEXICO, Mexico City, DISTRITO FEDERAL, Mexico; 2GASTROENTEROLOGY DEPARTMENT, HOSPITAL GENERAL DE MEXICO, MEXICO CITY, D.F., Mexico
BACKGROUND. Acute cholecystitis AC is one of the most common causes of surgery in the emergency room services. Since 2007 we have used the diagnostic criteria and severity assessment criteria proposed by the Consensus of Tokyo TG07 and TG13. Gastroenterologist and Surgeons around the World use it as the gold standard to diagnose and determining the severity of the AC. Unfortunately, we have found there are many differences between Tokyo TG13 Severity Assessment Criteria and transoperative features in Laparoscopic Cholecystectomy. TG13 grade AC in three groups: Grade III severe AC is associated with dysfunction of some organs or systems; Grade II moderate AC is associated with any one of the following: Leukocytosis >18,000/mm3, Duration of complains >72h or Marked local inflammation and Grade I: AC does not meet the criteria of Grade III or Grade II. We have propose the Descriptive transoperative features tasble DTFT in laparoscopic cholecystectomy in cases of AC and allows to grade the severity of the AC, and evaluate the the concordance with the criteria and assessment in Tokyo guidelines and histopathological features HF. The conclusion was that concordance grade between DTFT and Tokyo criteria was little or almost nill. OBJECTIVE: To review the database of our study and find any explanation about the non concordance between Tokyo criteria, the HF and our proposed DTFT, in cases of AC. METHODOLOGY: 91 medical records of patients who were attended with the diagnosis of AC were reviewed.we classified the results in phases ranging from 1 to 3 according to Tokyo score (mild, moderate, and severe severity). A kappa test was realized to assess the degree of agreement between our DTFT and the Tokyo criteria using the software STATA v.14. RESULTS: The medical records of 91 patients treated for AC were reviewed, they were classified according to the criteria for severity of Tokyo in Phase I mild 22 patients (24.17%), stage II moderate 63 (69.23%) and Phase III severe 6 (6.59%). The criteria for classification in grade III was in 3 patients (50%) creatinine>2 mg / dl; 2 (33.33%) neurological deficit; and one (16.66%) with platelet <100,000 / mm3 account. Of the 63 patients was classified as Stage II moderate: 58 (92.06%) the evolution of the disease>72hrs, 6 (5.52%) leukocytes>18,000 / mm3. It is noteworthy that the duration of the illness was the main variable, obviously we could deduce that this affects other systems or organs, however, at reviewing the rest of the parameters they were not altered by this. CONCLUSION. Therefore, it may be desirable to rethink the criteria of severity, and this allows to have more consistent with the other scales, which in turn also require review and redefine its variables. Back to 2016 Annual Meeting |
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