PURPOSE: The Tokyo guidelines for diagnostic criteria and severity assessment of acute @entity2679 (AC), published in 2007, recommend early laparoscopic cholecystectomy (ELC) be done as soon as possible after the onset of symptoms. We conducted this study to analyze the changes in the therapeutic strategy for AC in a surgical center in Tunisia after the Tokyo guidelines were published. METHODS: Between January, 2005 and January, 2013, 649 @entity1 underwent cholecystectomy for AC at the Department of Surgery, Mohamed Tahar Maamouri Hospital in Nabeul, Tunisia. The study period was subdivided into before (n  =  192) and after (n  =  457) the publication of the Tokyo guidelines, that is, prior to and including 2007, and from 2008 onward, respectively. We reviewed @entity1 records retrospectively to collect demographic data, biochemical data, radiological findings, and postoperative outcomes. All these factors were compared between the groups. RESULTS: The duration of symptoms before surgery was significantly longer before 2008 (p  =  0.018). ELC was significantly more frequent after 2008 (p  =  0.001). Laparoscopic surgery was converted to open surgery in 16.1  % of @entity1 before 2008 vs. 7.8  % of @entity1 after 2008 (p  =  0.02). There were no significant differences in @entity1157 or @entity260 between the groups. The length of preoperative, postoperative, and total hospital stay was longer before 2008. CONCLUSIONS: ELC is a safe and effective therapeutic strategy for AC. The Tokyo guidelines resulted in a significant increase in the number of ELCs being performed and significantly reduced preoperative and total hospital stay without increasing intra- and @entity260 . Importantly, ELC reduced medical costs, which is crucial for a country with limited resources, such as Tunisia.

Could the Tokyo guidelines on the management of acute XXXX be adopted in developing countries? Experience of one center.

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity1157 :: ('MESH:D001649', 'Disease') :: ['bile duct injury'] @entity2679 :: ('MESH:D002764', 'Disease') :: ['cholecystitis'] @entity260 :: ('MESH:D011183', 'Disease') :: ['postoperative complications']
@entity2679 :: (MESH:D002764,Disease) :: ['cholecystitis']
