{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T22:06:07Z","timestamp":1792188367100,"version":"4.4.0"},"reference-count":78,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,12,20]],"date-time":"2017-12-20T00:00:00Z","timestamp":1513728000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Hepato Biliary Pancreat"],"published-print":{"date-parts":[[2018,1]]},"abstract":"Abstract<\/jats:title>\n \n We propose a new flowchart for the treatment of acute cholecystitis (\n AC<\/jats:styled-content>\n ) in the Tokyo Guidelines 2018 (TG18). Grade\n III AC<\/jats:styled-content>\n was not indicated for straightforward laparoscopic cholecystectomy (Lap\u2010C). Following analysis of subsequent clinical investigations and drawing on Big Data in particular,\n TG<\/jats:styled-content>\n 18 proposes that some Grade\n III AC<\/jats:styled-content>\n can be treated by Lap\u2010C when performed at advanced centers with specialized surgeons experienced in this procedure and for patients that satisfy certain strict criteria. For Grade I,\n TG<\/jats:styled-content>\n 18 recommends early Lap\u2010C if the patients meet the criteria of Charlson comorbidity index (\n CCI<\/jats:styled-content>\n ) \u22645 and American Society of Anesthesiologists physical status classification (\n ASA<\/jats:styled-content>\n \u2010\n PS<\/jats:styled-content>\n ) \u22642. For Grade\n II AC<\/jats:styled-content>\n , if patients meet the criteria of\n CCI<\/jats:styled-content>\n \u22645 and\n ASA<\/jats:styled-content>\n \u2010\n PS<\/jats:styled-content>\n \u22642,\n TG<\/jats:styled-content>\n 18 recommends early Lap\u2010C performed by experienced surgeons; and if not, after medical treatment and\/or gallbladder drainage, Lap\u2010C would be indicated.\n TG<\/jats:styled-content>\n 18 proposes that Lap\u2010C is indicated in Grade\n III<\/jats:styled-content>\n patients with strict criteria. These are that the patients have favorable organ system failure, and negative predictive factors, who meet the criteria of\n CCI<\/jats:styled-content>\n \u22643 and\n ASA<\/jats:styled-content>\n \u2010\n PS<\/jats:styled-content>\n \u22642 and who are being treated at an advanced center (where experienced surgeons practice). If the patient is not considered suitable for early surgery,\n TG<\/jats:styled-content>\n 18 recommends early\/urgent biliary drainage followed by delayed Lap\u2010C once the patient's overall condition has improved. Free full articles and mobile app of TG18 are available at:\n http:\/\/www.jshbps.jp\/modules\/en\/index.php?content_id=47<\/jats:ext-link>\n . Related clinical questions and references are also included.\n <\/jats:p>","DOI":"10.1002\/jhbp.516","type":"journal-article","created":{"date-parts":[[2017,10,16]],"date-time":"2017-10-16T16:05:22Z","timestamp":1508169922000},"page":"55-72","source":"Crossref","is-referenced-by-count":782,"title":["Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis"],"prefix":"10.1002","volume":"25","author":[{"given":"Kohji","family":"Okamoto","sequence":"first","affiliation":[{"name":"Department of Surgery Center for Gastroenterology and Liver Disease Kitakyushu City Yahata Hospital Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenji","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Surgery Fujinomiya City General Hospital Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tadahiro","family":"Takada","sequence":"additional","affiliation":[{"name":"Department of Surgery Teikyo 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