The timing of laparoscopic cholecystectomy and nano-ligation clip for acute calculous cholecystitis under guidance of Tokyo guidelines 2018 (multi-center retrospective analysis)

Laparoscopic cholecystectomy (LC) has been recognized as the standard surgical method for cholecystectomy. A nano-absorbable ligation clip. The material used in the ligation clip is composed of basic materials (poly(p-dioxanone), poly trimethylene carbonate or polycaprolactone) and nano-short fibers (Polyglycolide acid or polylactide). The short nano-fibers maintain the crystalline form evenly dispersed in the base material. The diameter of short nano-fibers is 300-500 nm and the length is 20-50 mu m. The nano-absorbable ligation clip has strong closing force and will not cause closure failure. However, there are still some controversies about the optimum time for LC treatment of acute calculous cholecystitis (ACC) patients, and the optimum time for performing LC based on evidence-based medicine has not been unanimously recognized. Here, we explore LC timing for ACC treatment under the guidance of the Tokyo Guidelines for Acute Cholecystitis 2018 (TG18). We retrospectively analyzed the data of 3,147 ACC cases undergoing LC in eight hospitals in China. According to the time from the onset of the patient's symptoms to the operation, they were divided into the following three groups: Group A (onset to operation time of <= 3 days), Group B (onset to operation time of 4-7 days), and Group C (onset to operation time of >7 days). There was no obvious statistical difference in preoperative indicators, such as gender ratio, history of hypertension, diabetes, and abdominal operation; ASA Classification; and TG18 Classification between the three groups. Similarly, the results of preoperative laboratory indices (e.g., white blood cell, C-reactive protein, procalcitonin, platelet, serum creatinine, and international normalized ratio) showed no obvious statistical difference between the three groups. The comparison of gallbladder characteristics under B-ultrasound showed no significant statistical difference between the three groups. However, the conversion rate in Group C was significantly higher than that in Groups A and B, the incidence of complications (e.g., bile leakage, bile duct injury, and wound infection) was significantly higher in Group C than that in Groups A and B, and the postoperative hospital stay was significantly shorter in Group A than that in Groups B and C. A comprehensive analysis of patients' medical records in multiple medical centers confirms that it is safe and feasible to perform early LC 7 days before the onset of ACC, which can significantly decrease postoperative complications and shorten the postoperative hospital stay for ACC patients. Performing early LC for ACC patients under the TG18 guidelines is safe and feasible. Additionally, since TG18 has obvious practicability and guidance for the clinical practice of hepatobiliary surgery, it is worthy of popularization and application in China.