Early laparoscopic cholecystectomy for acute cholecystitis following the Tokyo Guidelines 2018: a prospective single-center study of 201 consecutive cases
Background Early laparoscopic cholecystectomy (ELC) for acute cholecystitis (AC) poses multiple challenges. The Tokyo Guidelines 2018 (TG18) eliminated the time limit (
Gespeichert in:
| Veröffentlicht in: | Surgical endoscopy 2023-08, Vol.37 (8), p.6051-6061 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 6061 |
|---|---|
| container_issue | 8 |
| container_start_page | 6051 |
| container_title | Surgical endoscopy |
| container_volume | 37 |
| creator | Mishima, Kohei Fujiyama, Yoshiki Wakabayashi, Taiga Igarashi, Kazuharu Ozaki, Takahiro Honda, Masayuki Mori, Shozo Funamizu, Naotake Tsutsui, Atsuko Okamoto, Nobuhiko Marescaux, Jacques Wakabayashi, Go |
| description | Background
Early laparoscopic cholecystectomy (ELC) for acute cholecystitis (AC) poses multiple challenges. The Tokyo Guidelines 2018 (TG18) eliminated the time limit ( |
| doi_str_mv | 10.1007/s00464-023-10094-x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2807916020</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2807916020</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-4347bf7e893f22045ce1d6ec1be5e87f773d3156efaaa49c55c407296b96c9d23</originalsourceid><addsrcrecordid>eNp9kc9u1DAQhy0EotvCC3BAlrhwCfhf4pgbqtqCVIlLOVteZ9K6eOPgcUrzKjwtXrZQiQMny55vvhnrR8grzt5xxvR7ZEx1qmFCNvVuVHP_hGy4kqIRgvdPyYYZyRqhjToix4i3rPKGt8_JkdSc90zyDfl55nJcaXSzywl9moOn_iZF8CsW8CXtVjqmTJ1fCjxWQglY32NMP8J0TcsN0Kv0bU30YgkDxDABUsF4_4E6OlfxXFXhDihWOkLjYSqQKZZlWGka9yj1aUKoU_aYdwj4gjwbXUR4-XCekK_nZ1enn5rLLxefTz9eNl7qtjRKKr0dNfRGjkIw1XrgQweeb6GFXo9ay0HytoPROaeMb1uvmBam25rOm0HIE_L24K2Lfl8Ai90F9BCjmyAtaEXPtOEdE6yib_5Bb9OSp7pdpWTHWa-MrJQ4UL7-HDOMds5h5_JqObP75OwhOVuTs7-Ts_e16fWDetnuYPjb8ieqCsgDgLU0XUN-nP0f7S-55qZ4</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2836108493</pqid></control><display><type>article</type><title>Early laparoscopic cholecystectomy for acute cholecystitis following the Tokyo Guidelines 2018: a prospective single-center study of 201 consecutive cases</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Mishima, Kohei ; Fujiyama, Yoshiki ; Wakabayashi, Taiga ; Igarashi, Kazuharu ; Ozaki, Takahiro ; Honda, Masayuki ; Mori, Shozo ; Funamizu, Naotake ; Tsutsui, Atsuko ; Okamoto, Nobuhiko ; Marescaux, Jacques ; Wakabayashi, Go</creator><creatorcontrib>Mishima, Kohei ; Fujiyama, Yoshiki ; Wakabayashi, Taiga ; Igarashi, Kazuharu ; Ozaki, Takahiro ; Honda, Masayuki ; Mori, Shozo ; Funamizu, Naotake ; Tsutsui, Atsuko ; Okamoto, Nobuhiko ; Marescaux, Jacques ; Wakabayashi, Go</creatorcontrib><description>Background
Early laparoscopic cholecystectomy (ELC) for acute cholecystitis (AC) poses multiple challenges. The Tokyo Guidelines 2018 (TG18) eliminated the time limit (< 72 h) and expanded the surgical indication to severe AC. This study aimed to evaluate the clinical outcomes of ELC for AC following the TG18 in a single high-volume center.
Methods
From 2019 to 2021, we managed all AC patients with a TG18 flowchart and prospectively enrolled those who underwent ELC within 7 days of symptom onset. The primary outcome was overall morbidity, with a comparison between mild (Grade I) and moderate/severe (Grade II/III) AC.
Results
During the study period, 201 patients underwent ELC was for Grade I (56.2%), II (40.3%), and III (3.5%) ACs. Mean age was 69 ± 15.2 years and time to surgery from symptom onset was 0 (12.9%), 1–3 (66.7%), and 4–7 days (20.4%). Mean operative time and blood loss were 118.9 ± 42.7 min and 57.8 ± 99.4 mL, respectively. The critical view of safety (CVS) was achieved in 76.1% of patients, and bailout procedures were performed in 21.4%. There were no open conversions or bile duct injuries. Major morbidities (Clavien–Dindo classification ≥ IIIa) were observed in 5.5% of cases and mortality in 0.5%. Comparing Grades II/III to Grade I, operative time was longer (112.3 vs. 127.3 min,
p
= 0.014), blood loss was higher (40.3 vs. 80.1 mL,
p
= 0.005), the CVS rate was lower (83.2 vs. 67.0%,
p
= 0.012), and the major morbidity rate was higher (1.8 vs. 10.2%,
p
= 0.012). In the subgroup analysis of Grade II/III, there were no significant differences in major morbidities (
p
= 0.288) between the two groups (0–3 vs. 4–7 days).
Conclusion
ELC for AC following TG18 is feasible with low morbidity rates. However, ELC for Grade II/III ACs remains challenging, and surgeons must carefully assess intraoperative difficulties and surgical risks before proceeding.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-023-10094-x</identifier><identifier>PMID: 37118031</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdominal Surgery ; Aged ; Aged, 80 and over ; Cholecystectomy ; Cholecystectomy, Laparoscopic - adverse effects ; Cholecystectomy, Laparoscopic - methods ; Cholecystitis, Acute - diagnosis ; Cholecystitis, Acute - surgery ; Gallbladder diseases ; Gastroenterology ; Gynecology ; Hepatology ; Humans ; Laparoscopy ; Medicine ; Medicine & Public Health ; Middle Aged ; Morbidity ; Proctology ; Prospective Studies ; Retrospective Studies ; Surgery ; Tokyo ; Treatment Outcome</subject><ispartof>Surgical endoscopy, 2023-08, Vol.37 (8), p.6051-6061</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-4347bf7e893f22045ce1d6ec1be5e87f773d3156efaaa49c55c407296b96c9d23</citedby><cites>FETCH-LOGICAL-c375t-4347bf7e893f22045ce1d6ec1be5e87f773d3156efaaa49c55c407296b96c9d23</cites><orcidid>0000-0003-4284-2989</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-023-10094-x$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-023-10094-x$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27923,27924,41487,42556,51318</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37118031$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mishima, Kohei</creatorcontrib><creatorcontrib>Fujiyama, Yoshiki</creatorcontrib><creatorcontrib>Wakabayashi, Taiga</creatorcontrib><creatorcontrib>Igarashi, Kazuharu</creatorcontrib><creatorcontrib>Ozaki, Takahiro</creatorcontrib><creatorcontrib>Honda, Masayuki</creatorcontrib><creatorcontrib>Mori, Shozo</creatorcontrib><creatorcontrib>Funamizu, Naotake</creatorcontrib><creatorcontrib>Tsutsui, Atsuko</creatorcontrib><creatorcontrib>Okamoto, Nobuhiko</creatorcontrib><creatorcontrib>Marescaux, Jacques</creatorcontrib><creatorcontrib>Wakabayashi, Go</creatorcontrib><title>Early laparoscopic cholecystectomy for acute cholecystitis following the Tokyo Guidelines 2018: a prospective single-center study of 201 consecutive cases</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
Early laparoscopic cholecystectomy (ELC) for acute cholecystitis (AC) poses multiple challenges. The Tokyo Guidelines 2018 (TG18) eliminated the time limit (< 72 h) and expanded the surgical indication to severe AC. This study aimed to evaluate the clinical outcomes of ELC for AC following the TG18 in a single high-volume center.
Methods
From 2019 to 2021, we managed all AC patients with a TG18 flowchart and prospectively enrolled those who underwent ELC within 7 days of symptom onset. The primary outcome was overall morbidity, with a comparison between mild (Grade I) and moderate/severe (Grade II/III) AC.
Results
During the study period, 201 patients underwent ELC was for Grade I (56.2%), II (40.3%), and III (3.5%) ACs. Mean age was 69 ± 15.2 years and time to surgery from symptom onset was 0 (12.9%), 1–3 (66.7%), and 4–7 days (20.4%). Mean operative time and blood loss were 118.9 ± 42.7 min and 57.8 ± 99.4 mL, respectively. The critical view of safety (CVS) was achieved in 76.1% of patients, and bailout procedures were performed in 21.4%. There were no open conversions or bile duct injuries. Major morbidities (Clavien–Dindo classification ≥ IIIa) were observed in 5.5% of cases and mortality in 0.5%. Comparing Grades II/III to Grade I, operative time was longer (112.3 vs. 127.3 min,
p
= 0.014), blood loss was higher (40.3 vs. 80.1 mL,
p
= 0.005), the CVS rate was lower (83.2 vs. 67.0%,
p
= 0.012), and the major morbidity rate was higher (1.8 vs. 10.2%,
p
= 0.012). In the subgroup analysis of Grade II/III, there were no significant differences in major morbidities (
p
= 0.288) between the two groups (0–3 vs. 4–7 days).
Conclusion
ELC for AC following TG18 is feasible with low morbidity rates. However, ELC for Grade II/III ACs remains challenging, and surgeons must carefully assess intraoperative difficulties and surgical risks before proceeding.</description><subject>Abdominal Surgery</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cholecystectomy</subject><subject>Cholecystectomy, Laparoscopic - adverse effects</subject><subject>Cholecystectomy, Laparoscopic - methods</subject><subject>Cholecystitis, Acute - diagnosis</subject><subject>Cholecystitis, Acute - surgery</subject><subject>Gallbladder diseases</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Laparoscopy</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Proctology</subject><subject>Prospective Studies</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Tokyo</subject><subject>Treatment Outcome</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kc9u1DAQhy0EotvCC3BAlrhwCfhf4pgbqtqCVIlLOVteZ9K6eOPgcUrzKjwtXrZQiQMny55vvhnrR8grzt5xxvR7ZEx1qmFCNvVuVHP_hGy4kqIRgvdPyYYZyRqhjToix4i3rPKGt8_JkdSc90zyDfl55nJcaXSzywl9moOn_iZF8CsW8CXtVjqmTJ1fCjxWQglY32NMP8J0TcsN0Kv0bU30YgkDxDABUsF4_4E6OlfxXFXhDihWOkLjYSqQKZZlWGka9yj1aUKoU_aYdwj4gjwbXUR4-XCekK_nZ1enn5rLLxefTz9eNl7qtjRKKr0dNfRGjkIw1XrgQweeb6GFXo9ay0HytoPROaeMb1uvmBam25rOm0HIE_L24K2Lfl8Ai90F9BCjmyAtaEXPtOEdE6yib_5Bb9OSp7pdpWTHWa-MrJQ4UL7-HDOMds5h5_JqObP75OwhOVuTs7-Ts_e16fWDetnuYPjb8ieqCsgDgLU0XUN-nP0f7S-55qZ4</recordid><startdate>20230801</startdate><enddate>20230801</enddate><creator>Mishima, Kohei</creator><creator>Fujiyama, Yoshiki</creator><creator>Wakabayashi, Taiga</creator><creator>Igarashi, Kazuharu</creator><creator>Ozaki, Takahiro</creator><creator>Honda, Masayuki</creator><creator>Mori, Shozo</creator><creator>Funamizu, Naotake</creator><creator>Tsutsui, Atsuko</creator><creator>Okamoto, Nobuhiko</creator><creator>Marescaux, Jacques</creator><creator>Wakabayashi, Go</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4284-2989</orcidid></search><sort><creationdate>20230801</creationdate><title>Early laparoscopic cholecystectomy for acute cholecystitis following the Tokyo Guidelines 2018: a prospective single-center study of 201 consecutive cases</title><author>Mishima, Kohei ; Fujiyama, Yoshiki ; Wakabayashi, Taiga ; Igarashi, Kazuharu ; Ozaki, Takahiro ; Honda, Masayuki ; Mori, Shozo ; Funamizu, Naotake ; Tsutsui, Atsuko ; Okamoto, Nobuhiko ; Marescaux, Jacques ; Wakabayashi, Go</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-4347bf7e893f22045ce1d6ec1be5e87f773d3156efaaa49c55c407296b96c9d23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Abdominal Surgery</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cholecystectomy</topic><topic>Cholecystectomy, Laparoscopic - adverse effects</topic><topic>Cholecystectomy, Laparoscopic - methods</topic><topic>Cholecystitis, Acute - diagnosis</topic><topic>Cholecystitis, Acute - surgery</topic><topic>Gallbladder diseases</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Laparoscopy</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>Proctology</topic><topic>Prospective Studies</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Tokyo</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mishima, Kohei</creatorcontrib><creatorcontrib>Fujiyama, Yoshiki</creatorcontrib><creatorcontrib>Wakabayashi, Taiga</creatorcontrib><creatorcontrib>Igarashi, Kazuharu</creatorcontrib><creatorcontrib>Ozaki, Takahiro</creatorcontrib><creatorcontrib>Honda, Masayuki</creatorcontrib><creatorcontrib>Mori, Shozo</creatorcontrib><creatorcontrib>Funamizu, Naotake</creatorcontrib><creatorcontrib>Tsutsui, Atsuko</creatorcontrib><creatorcontrib>Okamoto, Nobuhiko</creatorcontrib><creatorcontrib>Marescaux, Jacques</creatorcontrib><creatorcontrib>Wakabayashi, Go</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mishima, Kohei</au><au>Fujiyama, Yoshiki</au><au>Wakabayashi, Taiga</au><au>Igarashi, Kazuharu</au><au>Ozaki, Takahiro</au><au>Honda, Masayuki</au><au>Mori, Shozo</au><au>Funamizu, Naotake</au><au>Tsutsui, Atsuko</au><au>Okamoto, Nobuhiko</au><au>Marescaux, Jacques</au><au>Wakabayashi, Go</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early laparoscopic cholecystectomy for acute cholecystitis following the Tokyo Guidelines 2018: a prospective single-center study of 201 consecutive cases</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2023-08-01</date><risdate>2023</risdate><volume>37</volume><issue>8</issue><spage>6051</spage><epage>6061</epage><pages>6051-6061</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
Early laparoscopic cholecystectomy (ELC) for acute cholecystitis (AC) poses multiple challenges. The Tokyo Guidelines 2018 (TG18) eliminated the time limit (< 72 h) and expanded the surgical indication to severe AC. This study aimed to evaluate the clinical outcomes of ELC for AC following the TG18 in a single high-volume center.
Methods
From 2019 to 2021, we managed all AC patients with a TG18 flowchart and prospectively enrolled those who underwent ELC within 7 days of symptom onset. The primary outcome was overall morbidity, with a comparison between mild (Grade I) and moderate/severe (Grade II/III) AC.
Results
During the study period, 201 patients underwent ELC was for Grade I (56.2%), II (40.3%), and III (3.5%) ACs. Mean age was 69 ± 15.2 years and time to surgery from symptom onset was 0 (12.9%), 1–3 (66.7%), and 4–7 days (20.4%). Mean operative time and blood loss were 118.9 ± 42.7 min and 57.8 ± 99.4 mL, respectively. The critical view of safety (CVS) was achieved in 76.1% of patients, and bailout procedures were performed in 21.4%. There were no open conversions or bile duct injuries. Major morbidities (Clavien–Dindo classification ≥ IIIa) were observed in 5.5% of cases and mortality in 0.5%. Comparing Grades II/III to Grade I, operative time was longer (112.3 vs. 127.3 min,
p
= 0.014), blood loss was higher (40.3 vs. 80.1 mL,
p
= 0.005), the CVS rate was lower (83.2 vs. 67.0%,
p
= 0.012), and the major morbidity rate was higher (1.8 vs. 10.2%,
p
= 0.012). In the subgroup analysis of Grade II/III, there were no significant differences in major morbidities (
p
= 0.288) between the two groups (0–3 vs. 4–7 days).
Conclusion
ELC for AC following TG18 is feasible with low morbidity rates. However, ELC for Grade II/III ACs remains challenging, and surgeons must carefully assess intraoperative difficulties and surgical risks before proceeding.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>37118031</pmid><doi>10.1007/s00464-023-10094-x</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0003-4284-2989</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0930-2794 |
| ispartof | Surgical endoscopy, 2023-08, Vol.37 (8), p.6051-6061 |
| issn | 0930-2794 1432-2218 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2807916020 |
| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Abdominal Surgery Aged Aged, 80 and over Cholecystectomy Cholecystectomy, Laparoscopic - adverse effects Cholecystectomy, Laparoscopic - methods Cholecystitis, Acute - diagnosis Cholecystitis, Acute - surgery Gallbladder diseases Gastroenterology Gynecology Hepatology Humans Laparoscopy Medicine Medicine & Public Health Middle Aged Morbidity Proctology Prospective Studies Retrospective Studies Surgery Tokyo Treatment Outcome |
| title | Early laparoscopic cholecystectomy for acute cholecystitis following the Tokyo Guidelines 2018: a prospective single-center study of 201 consecutive cases |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-13T01%3A53%3A41IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Early%20laparoscopic%20cholecystectomy%20for%20acute%20cholecystitis%20following%20the%20Tokyo%20Guidelines%202018:%20a%20prospective%20single-center%20study%20of%20201%20consecutive%20cases&rft.jtitle=Surgical%20endoscopy&rft.au=Mishima,%20Kohei&rft.date=2023-08-01&rft.volume=37&rft.issue=8&rft.spage=6051&rft.epage=6061&rft.pages=6051-6061&rft.issn=0930-2794&rft.eissn=1432-2218&rft_id=info:doi/10.1007/s00464-023-10094-x&rft_dat=%3Cproquest_cross%3E2807916020%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2836108493&rft_id=info:pmid/37118031&rfr_iscdi=true |