Abstract

Background: Acute cholecystitis remains a common surgical emergency with variable management approaches. The Tokyo Guidelines 2018 (TG18) provide a standardized severity grading system and treatment algorithm, yet prospective validation comparing TG18-guided management with traditional clinical judgment remains limited. This study aimed to validate the clinical utility of TG18-based decision-making in improving patient outcomes. Methods: This prospective comparative study was conducted at the Department of General Surgery, Sardar Patel Medical College, Bikaner. A total of 124 patients with acute cholecystitis were randomized into two groups: Group A (n=83) managed according to TG18 protocol, and Group B (n=41) managed using traditional clinical judgment. Primary outcome was total complication rate. Secondary outcomes included specific complications (bile leak, ICU requirement, post-operative infection, 30-day readmission) and length of hospital stay. Statistical analysis included chi-square test, t-test, and multivariate logistic regression. Results: Tokyo severity grade distribution was comparable between groups (p=0.624). Total complication rate was significantly lower in Group A compared to Group B (16.9% vs 43.9%, p=0.001; OR 3.84, 95% CI 1.67–8.82). Bile leak occurred in 1.2% versus 31.7% (p<0.001), ICU requirement in 4.8% versus 26.8% (p=0.001), and 30-day readmission in 1.2% versus 12.2% (p=0.014). Mean hospital stay was significantly shorter in Group A (4.4±1.6 vs 11.0±4.8 days, p<0.001). Laparoscopic cholecystectomy rate was higher in Group A (69.9% vs 29.3%, p<0.001). Multivariate analysis confirmed TG18 guidance as independently protective (adjusted OR 2.89, 95% CI 1.12–7.46, p=0.028). Conclusion: TG18-guided management significantly reduces complications and hospital stay in acute cholecystitis. Implementation of Tokyo Guidelines 2018 as standard protocol is recommended for optimal patient outcomes.

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Data Sharing Statement

Funding