AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |
Back to Blog
Update for bridge baron 153/25/2023 The approach of the WSES guidelines was to simplify the initial management of patients presenting with suspected ACC. In particular, the direct link between diagnostic criteria for ACC, severity classification and therapeutic indications described in the TG13 are limited by lack of quality evidence. In 2016, the World Society of Emergency Surgery (WSES) published the first edition of their guidelines for ACC, which presented different diagnostic and therapeutic algorithms, compared with the Tokyo Guidelines (TG), known at that time as Tokyo Guidelines 2013 (TG13). However, considering the heterogeneity of clinical scenarios, the variability in hospital facilities and in the availability of expertise, the management of patients with right upper quadrant abdominal pain may vary. Cholecystectomy is the most common therapeutic approach for ACC and is considered the standard of care for gallstone disease for the majority of patients. Between 20 and 40% of patients with gallstones will develop gallstone-related complications, with an incidence of 1–3% annually acute calculus cholecystitis (ACC) is the first clinical presentation in 10–15% of the cases. The estimated overall prevalence of gallstones is 10–15% in the general population, with some differences across countries. The development of local policies for safe laparoscopic cholecystectomy is recommended. Further evidence on the role of clinical judgement and the use of clinical scores as adjunctive tools to guide treatment of high-risk patients and patients who are not suitable for surgery is required. The value of surgical treatment for high-risk patients should lead to a distinction between high-risk patients and patients who are not suitable for surgery. Conclusions, knowledge gaps and research recommendationsĮLC has a central role in the management of patients with ACC. Subtotal cholecystectomy is safe and represents a valuable option in cases of difficult gallbladder removal. Early laparoscopic cholecystectomy (ELC) should be the standard of care whenever possible, even in subgroups of patients who are considered fragile, such as the elderly those with cardiac disease, renal disease and cirrhosis or those who are generally at high risk for surgery. When compared with the WSES 2016 guidelines, the role of gallbladder drainage is reduced, despite the considerable technical improvements available. The pivotal role of surgery is confirmed, including in high-risk patients. A revised version of the statements was voted upon via an online questionnaire until consensus was reached. All the statements were presented, discussed and voted upon during the Consensus Conference at the 6th World Congress of the World Society of Emergency Surgery held in Nijmegen (NL) in May 2019. The quality of evidence and strength of recommendations were reviewed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria (see ). Relevant key questions were constructed, and the task force produced drafts of each section based on the best scientific evidence from PubMed and EMBASE Library recommendations were developed in order to answer these key questions. The WSES president appointed four members as a scientific secretariat, four members as an organization committee and four members as a scientific committee, choosing them from the expert affiliates of WSES. The presence of several areas of uncertainty, along with the availability of new evidence, prompted the current update of the 2016 WSES (World Society of Emergency Surgery) Guidelines on ACC. World Journal of Emergency Surgery volume 15, Article number: 61 ( 2020)Īcute calculus cholecystitis (ACC) has a high incidence in the general population. 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis
0 Comments
Read More
Leave a Reply. |