Heterogeneity in Tokyo Guidelines 2018 grade II acute cholecystitis: association of local complications with operative difficulty and postoperative morbidity
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background Tokyo Guidelines 2018 (TG18) grade II acute cholecystitis (AC) includes a heterogeneous group of patients. This study evaluated whether patients classified as TG18 grade II AC due to local complications had greater operative difficulty and postoperative morbidity, and explored factors associated with this subgroup. Methods A retrospective observational study including all TG18 grade II AC patients undergoing laparoscopic cholecystectomy was performed. Patients were stratified into a locally complicated group (LCG) and a non-locally complicated group (NLCG). Multivariable logistic regression identified factors associated with LCG. Results: A total of 207 patients were analyzed; 70 (33.8%) were classified as LCG. Compared with NLCG, LCG patients had greater operative difficulty (92.9% vs 70.8%; OR 5.36, 95% CI 2.01 - 14.30; p < 0.001), higher overall postoperative complications (11.4% vs 2.2%; OR 5.76, 95% CI 1.48 - 22.47; p=0.008), major complications (8.6% vs 0.7%; OR 12.75, 95% CI 1.50 - 108.13; p=0.007), and bile leak (7.1% vs 0.7%; OR 10.46, 95% CI 1.20 - 91.38; p=0.01). Age (OR 1.02, 95% CI 1.00 - 1.04), male sex (OR 2.39, 95% CI 1.27 - 4.50), and comorbidities (OR 4.28, 95% CI 1.77 - 10.33) were independently associated with LCG. Conclusions Among TG18 grade II AC patients, LCG represents a higher-risk subgroup with greater operative difficulty and worse postoperative outcomes.
Institution: Argerich Hospital
Language: English
Subfield: Gastroenterology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7204073243