Medical Calculators › Biliary Surgery › AAST Cholecystitis Grade

AAST Cholecystitis Grade

American Association for the Surgery of Trauma — Intraoperative Severity Grading

Intraoperative severity classification for acute cholecystitis. Guides operative decision-making during laparoscopic cholecystectomy — from standard technique to open emergency surgery.

General Surgery Biliary Surgery Intraoperative Assessment
AAST Cholecystitis Grade
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AAST Grade
Select a grade above

Grading & Management

Grade Finding Management
I Oedema only Standard LC
II Pericholecystic inflammation Standard LC; IOC recommended
III Gangrene or necrosis Expert surgeon; subtotal cholecystectomy if needed
IV Perforation (localised/free) Lavage; drain; open or subtotal; damage control if needed
V Biliary peritonitis Emergency open surgery; washout; ICU

Clinical Application

  • AAST grading is applied intraoperatively and guides real-time decision-making
  • Grade I–II: standard laparoscopic approach safe and appropriate
  • Grade III (gangrenous cholecystitis): subtotal cholecystectomy is a safe exit strategy — resect anterior wall, leave posterior wall on liver, oversew or staple the remnant cystic duct, drain
  • Grade IV: liver bed damage control; if perforation is localised, may still complete LC; if free, open conversion and washout
  • Grade V: requires emergency laparotomy, peritoneal washout, drain, and HDU/ICU care
  • Compare with Tokyo Guidelines TG18 (preoperative grading) for pre- vs. intraoperative assessment

References

  1. Tominaga GT, et al. AAST-EAST guidelines on cholecystitis. J Trauma Acute Care Surg. 2016.
  2. Madni TD, et al. Gallbladder perforation and associated morbidity and mortality. Am J Surg. 2019.

Related Calculators

Tokyo TG18 Cholecystitis Nassar Score