Abstract
ObjectivesDiabetes mellitus predisposes to the formation of gallstones. Surgery for gallstone disease (GSD) in diabetic patients also carries more risk compared with nondiabetic patients. The objective of the present study was to evaluate the intraoperative findings of elective laparoscopic cholecystectomy in diabetics and nondiabetics.MethodsThis study was carried out for two years in the department of general surgery as a prospective observational study. Two groups of patients with uncomplicated gallstone disease were recruited: one group included 75 diabetics and the other one included 75 nondiabetics. The two study groups were matched by age and gender. Detailed history and intraoperative findings and their outcomes were recorded. Patients with emergencylaparoscopiccholecystectomy for acute cholecystitis and its complications and cholecystectomy associated with common bile duct (CBD) stones were excluded from the study.ResultsThe results of elective laparoscopic cholecystectomy in the groups were compared. No demographic differences were found between the groups. Adverse intraoperative findings such as thick-walled gallbladder (GB), pericholecystic collections, and adhesions to the surrounding structures, surgical difficulties, modification to subtotal cholecystectomy, and open conversion were more frequent in diabetic patients than in nondiabetic patients.ConclusionLaparoscopic cholecystectomy in diabetic patients had more adverse intraoperative findings in comparison to nondiabetic patients. However, in elective laparoscopic cholecystectomy, good preoperative preparation and meticulous surgical technique are mandatory to achieve similar outcomes between the groups.
Highlights
Patients with emergency laparoscopic cholecystectomy for acute cholecystitis and its complications and cholecystectomy associated with common bile duct (CBD) stones were excluded from the study
No demographic differences were found between the groups. Adverse intraoperative findings such as thick-walled gallbladder (GB), pericholecystic collections, and adhesions to the surrounding structures, surgical difficulties, modification to subtotal cholecystectomy, and open conversion were more frequent in diabetic patients than in nondiabetic patients
Laparoscopic cholecystectomy is the gold standard for all symptomatic gallstone disease (GSD), and its prevalence is higher in patients with diabetes compared with those without
Summary
Laparoscopic cholecystectomy is the gold standard for all symptomatic gallstone disease (GSD), and its prevalence is higher in patients with diabetes compared with those without. Diabetics are more susceptible to infections, as high blood sugar levels can weaken the patient’s immune system defense and hamper normal healing mechanisms. Diabetics along with various factors such as obesity-associated diabetes, insulin resistance, high triglyceride level, and autonomic neuropathy interplay in the formation of gallstones [1]. The morbidity and mortality in diabetes are mostly due to severe inflammation in diabetes and silent presentation. Diabetes is considered an independent risk factor for intraoperative complications, but in well-controlled diabetes with good preoperative preparation and surgical technique, the outcome is the same in both diabetic and nondiabetic groups [2,3]
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