Abstract
Background
Diabetes mellitus is associated with an increased risk of complications after abdominal surgery. We evaluated retrospectively the impact of preoperative risk factors and outcome of diabetic patients after laparoscopic cholecystectomy (LC) compared with open cholecystectomy (OC) for symptomatic gallstones.
Methods
Altogether 2,548 consecutive patients (1,581 LC, 967 OC) with symptomatic gallstones underwent cholecystectomy at our secondary referral center, being the only operative unit in the catchment area. Between the years 1995 and 2008, we operated 227 (9%) patients with diabetes, of whom 45 (20%) had type 1 diabetes. Preoperative data and operative outcome of the diabetic patients undergoing LC (n = 102) and OC (n = 125) were compared. The effect of comorbidities of diabetes on the risk for postoperative complications was analyzed by multiple logistic regression analysis.
Results
The percentage of morbidly obese diabetic patients did not change during the study period. Almost half of the cholecystectomies (n = 111) in diabetics were performed as acute surgery due to cholecystitis. Conversion to open surgery was required in 16% of the diabetic patients undergoing LC compared with 7% in the nondiabetic controls (p < 0.0001). Mortality rate was zero and nine patients (7.2%), respectively, in the LC and OC groups (p < 0.01). Other complications were also more frequently observed in the OC than LC groups. This outcome difference was unchanged during time. On multivariate analysis, comorbidities of diabetes were associated with an elevated risk for complications, but obesity or acute surgery was not independently associated with postoperative complications.
Conclusions
When feasible, LC was a safe procedure in diabetes. Open surgery with comorbidities increased the operative risks. Our study was not randomized, and therefore selection bias to type of procedure may affect the results.
Similar content being viewed by others
References
Bell DSH, Allbright E (2007) The multifaceted associations of hepatobiliary disease and diabetes. Endocrine Practice 13:300–312
Chapman BA, Wilson IR, Frampton CM (1996) Prevalence of gallbladder disease in diabetes mellitus. Dig Dis Sci 41:2222–2228
Pagliarulo M, Fornari F, Fraquelli M (2004) Gallstone disease and related risk factors in a large cohort of diabetic patients. Dig Liver Dis 36:130–134
Walsh DC, Eckhauser FE, Ramsburgh SR, Burney RB (1982) Risk associated with diabetes mellitus in patients undergoing gallbladder surgery. Surgery 91:254–257
Sandler RS, Maule WF, Baltus ME (1986) Factors associated with postoperative complications in diabetes after biliary tract surgery. Gastroenterology 91:157–162
Carbonell AM, Lincourt AE, Kercher KW, Matthews BD, Cobb WS, Sing RF, Heniford BT (2005) Do patient or hospital demographics predict cholecystectomy outcomes? A nationwide study of 93,578 patients. Surg Endosc 19:767
Rosenmuller M, Haapamaki MM, Nordin P, Stenlund H, Nilsson E (2007) Cholecystectomy in Sweden 2000–2003: a nationwide study on procedures, patient characteristics, and mortality. BMC Gastroenterol 17:35
Bedirli A, Sözuer EM, Yuksel O, Yilmaz Z (2001) Laparoscopic cholecystectomy for symptomatic gallstones in diabetic patients. J Laparoendosc Adv Surg Tech 11:281–284
Noel RA, Patterson RE, Braun DK, Bloomgren GL (2009) Increased risk of acute pancreatitis and biliary disease observed in patients with type 2 diabetes. Diabetes Care 32:834–838
Harjutsalo V, Sjöberg L, Tuomilehto J (2008) Time trends in the incidence of type 1 diabetes in Finnish children: a cohort study. Lancet 371:1777–1782
Hu G, Lindström J, Jousilahti P (2008) The increasing prevalence of metabolic syndrome among Finnish men and women over a decade. J Clin Endocrinol Metab 93:832–836
Shpitz B, Sigal A, Kaufman Z, Dinbar A (1995) Acute cholecystitis in diabetic patients. Am Surg 61:964–967
Patiño JF, Quintero GA (1998) Asymptomatic cholelithiasis revisited. World J Surg 22:1119–1124
Meshikhes AW (2002) Asymptomatic gallstones in the laparoscopic era. J R Coll Surg Edinb 47:742–748
Khan MH, Howard TJ, Fogel EL (2007) Frequency of biliary complications after laparoscopic cholecystectomy detected by ERCP: experience at a large tertiary referral center. Gastrointest Endosc 65:247
Aslar AK, Ertan T, Oguz H, Gocmen E, Koc M (2003) Impact of laparoscopy on frequency of surgery for treatment of gallstones. Surg Laparosc Endosc 13:315
Vollmer CM, Callery MP (2007) Biliary injury following laparoscopic cholecystectomy: why still a problem? Gastroenterology 133:1039
Ibrahim S, Hean TK, Ho LS (2006) Risk factors for conversion to open surgery in patients undergoing laparoscopic cholecystectomy. World J Surg 30:1698–1704
Pavlidis TE, Marakis GN, Ballas K (2007) Risk factors influencing conversion of laparoscopic to open cholecystectomy. J Laparoendosc Adv Surg Tech 17:414–418
Simopoulos C, Polychronidis A, Botaitis S, Perente S, Pitiakoudis M (2005) Laparoscopic cholecystectomy in obese patients. Obes Surg 15:243–246
Lipman JM, Claridge JA, Haridas M (2007) Preoperative findings predict conversion from laparoscopic to open cholecystectomy. Surgery 142:556–563
Katsika D, Grjibovski A, Einarsson C (2005) Genetic and environmental influences on symptomatic gallstone disease: a Swedish twin study. Hepatology 41:1138–1143
Tuveri M, Borsezio V, Calo PG (2009) Laparoscopic cholecystectomy in the obese: results with the traditional and fundus-first technique. J Laparoendosc Adv Surg Tech 19(6):735–740
Kim W, Song KY, Lee HJ, Han SU, Hyung WJ, Cho GS (2008) The impact of co-morbidity on surgical outcomes in laparoscopy-assisted distal gastrectomy: a retrospective analysis of multicenter results. Ann Surg 248:793–799
Fernandez AZ Jr, DeMaria EJ, Tichansky DS, Kellum JM, Wolfe LG, Meador J, Sugerman HJ (2004) Experience with over 3,000 open and laparoscopic bariatric procedures: multivariate analysis of factors related to leak and resultant mortality. Surg Endosc 18:193–197
Disclosures
Authors Hannu Paajanen, Satu Suuronen, Pia Nordström, Pekka Miettinen, and Leo Niskanen have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Paajanen, H., Suuronen, S., Nordstrom, P. et al. Laparoscopic versus open cholecystectomy in diabetic patients and postoperative outcome. Surg Endosc 25, 764–770 (2011). https://doi.org/10.1007/s00464-010-1248-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-010-1248-y