Relationship between the Tokyo Guidelines and Pathological Severity in Acute Cholecystitis

Abstract

Background: It is not well understood whether the severity of acute cholecystitis (AC) correlates with the extent of gallbladder (GB) inflammation or laboratory findings. This study aimed to assess whether the severity of AC, in accordance with the Tokyo Guidelines (TGs), is consistent with the extent of GB inflammation on histopathological and laboratory findings, including microbiological isolation in blood and bile. Methods: The medical records of patients who underwent cholecystectomy for AC between January 2017 and May 2020 were reviewed. Demographic data, laboratory findings, the microbiologic culture of blood and bile, the extent of GB inflammation, and stone composition were compared in accordance with the TGs. Results: A total of 217 patients were divided into three groups of increasing severity—Grade I (n = 146), Grade II (n = 51), and Grade III (n = 20)—in accordance with the TGs. The Grade III group contained significantly older patients compared with the Grade I or Grade II groups (Grade I, 56.9 ± 13.9; Grade II, 64.3 ± 15.4; Grade III, 69.9 ± 9.9; p-value p-value p-value Conclusions: AC severity, as stated by the TGs, does not correlate with the extent of GB inflammation on histopathological and laboratory findings. However, microbiological isolation in blood and bile was increased proportionally to the grade of the TGs.

Keywords

• acute cholecystitis
• severity
• Tokyo Guidelines
• gallbladder
• inflammation