ヒグチ　リヨウタ   Higuchi Riyouta   樋口　亮太    所属   医学部 医学科（附属八千代医療センター）    職種   講師
論文種別	原著
言語種別	英語
査読の有無	査読なし
表題	Tokyo Guidelines 2018: surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos).
掲載誌名	正式名：Journal of hepato-biliary-pancreatic sciences 略　 称：J Hepatobiliary Pancreat Sci ISSNコード：(1868-6982)1868-6974(Linking)
掲載区分	国内
巻・号・頁	25(1),pp.73-86
著者・共著者	WAKABAYASHI Go,IWASHITA Yukio,HIBIi Taizo,TAKEDA Tadahiro,Strasberg Steven M,Asbun Horacio J,ENDO Itaru,UMEZAWA Akiko,ASAI Koji,SUZUKI Kenji,MORI Yasuhisa,OKAMOTO Kohji, Pitt Henry A,Han Ho-Seong,Hwang Tsann-Long,Yoon Yoo-Seok,Yoon Dong-Sup,Choi In-Seok,Huang Wayne Shih-Wei,Giménez Mariano Eduardo,Garden O James,Gouma Dirk J,Belli Giulio,Dervenis Christos,Jagannath Palepu,Chan Angus C W,Lau Wan Yee,Liu Keng-Hao,Su Cheng-Hsi,MISAWA Takeyuki,NAKAMURA Masafumi,HORIGUCHI Akihiko,TAGAYA Nobumi,FUJIOKA Shuichi,HIGUCHI Ryota,SHIKATA Satoru,NOGUCHI Yoshinori,UKAI Tomohiko,YOKOE Masamichi,Cherqui Daniel,HONDA Goro,SUGIOKA Atsushi,de Santibañes Eduardo,Supe Avinash Nivritti,TOKUMURA Hiromi,KIMURA Taizo,YOSHIDA Masahiro,MAYUMI Toshihiko,KITANO Seigo,INOMATA Masafumi,HIRATA Koichi,SUMIYAMA Yoshinobu,INUI Kazuo,YAMAMOTO Masakazu
発行年月	2018/01
概要	In some cases, laparoscopic cholecystectomy (LC) may be difficult to perform in patients with acute cholecystitis (AC) with severe inflammation and fibrosis. The Tokyo Guidelines 2018 (TG18) expand the indications for LC under difficult conditions for each level of severity of AC. As a result of expanding the indications for LC to treat AC, it is absolutely necessary to avoid any increase in bile duct injury (BDI), particularly vasculo-biliary injury (VBI), which is known to occur at a certain rate in LC. Since the Tokyo Guidelines 2013 (TG13), an attempt has been made to assess intraoperative findings as objective indicators of surgical difficulty; based on expert consensus on these difficulty indicators, bail-out procedures (including conversion to open cholecystectomy) have been indicated for cases in which LC for AC is difficult to perform. A bail-out procedure should be chosen if, when the Calot's triangle is appropriately retracted and used as a landmark, a critical view of safety (CVS) cannot be achieved because of the presence of nondissectable scarring or severe fibrosis. We propose standardized safe steps for LC to treat AC. To achieve a CVS, it is vital to dissect at a location above (on the ventral side of) the imaginary line connecting the base of the left medial section (Segment 4) and the roof of Rouvière's sulcus and to fulfill the three criteria of CVS before dividing any structures. Achieving a CVS prevents the misidentification of the cystic duct and the common bile duct, which are most commonly confused. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.
DOI	10.1002/jhbp.517
PMID	29095575