Original single-incision laparoscopic cholecystectomy for acute inflammation of the gallbladder

Table 1 Tokyo guideline diagnostic criteria and severity assessment of acute cholecystitis

Diagnosis criteria

A: Local signs of inflammation

Murphy’s sign

Rright upper quadrant mass/pain/tenderness

B: Systemic signs of inflammation

Fever

Elevated C-reactive protein

Elevated white blood cell count

C: Imaging findings

Sonographic Murphy sign

Thickened gallbladder wall

Enlarged gallbladder

Pericholecystic fluid collection

Sonolucent layer in the gallbladder wall

Definite diagnosis

One item in A and one in B are positive

C confirms the diagnosis when acute cholecystitis is suspected clinically1

Severity assessment

Mild (grade I)

Acute cholecystitis does not meet the criteria of severe (grade III) or moderate (grade II) acute cholecystitis or acute cholecystitis in a healthy patient with no organ dysfunction and mild inflammatory changes in the gallbladder, making cholecystectomy a safe and low risk operative procedure

Moderate (grade II)

Elevated WBC count (> 18 000/mm3)

Palpable tender mass in the right upper quadrant

Duration of complains > 72 h2

Marked local inflammation (biliary peritonitis, pericholecystic abscess, hepatic abscess, gangrenous cholecystitis, emphysematous cholecystitis)

Severe (grade III)

Acute cholecystitis associated with dysfunction of any one of the following organs/systems

Cardiovascular dysfunction (hypotension requiring treatment with dopamine ≥ 5 μg/kg per minute, or any dose of dobutamine)

Neurological dysfunction (decreased level of consciousness)

Respiratory dysfunction (PaO2/FiO2 ratio < 300)

Renal dysfunction (oliguria, creatinine > 2.0 mg/dL)

Hepatic dysfunction (PT-INR > 1.5)

¹Acute hepatitis, other acute abdominal disease, and chronic cholecystitis should be excluded;

²Laparoscopic surgery should be performed within 96 h of the onset of acute cholecystitis. WBC: White blood cell; PT-INR: Prothrombin time and international normalized ratio.