Impact of Diabetes on Outcomes of Laparoscopic Cholecystectomy: A Prospective Study

Authors

  • Gohar Ali Hayatabad Medical Complex, Peshawar
  • Yousaf Jan Hayatabad Medical Complex, Peshawar, Pakistan
  • Almas Khattak Hayatabad Medical Complex, Peshawar
  • Jawad Ali Hayatabad Medical Complex, Peshawar
  • Muhammad Kashif Dawar Hayatabad Medical Complex, Peshawar
  • Anees Ahmad Hayatabad Medical Complex, Peshawar
  • Fazal Ullah Hayatabad Medical Complex, Peshawar

DOI:

https://doi.org/10.37762/jgmds.12-1.634

Keywords:

Diabetes, Intraoperative Findings, Complications, Laparoscopic Cholecystectomy

Abstract

OBJECTIVES

This study aims to assess the impact of diabetes on laparoscopic cholecystectomy (LC) outcomes, as optimizing results for diabetic patients undergoing this common surgery presents unique clinical challenges.

METHODOLOGY

We comprehensively analyzed 258 participants, comparing 60 individuals with diabetes to 198 non-diabetic counterparts. Key variables, including age, gender, BMI, comorbidities, ASA grade, and CCI index, were assessed. Additionally, intraoperative and postoperative characteristics, ultrasound findings, and outcomes were analyzed.
RESULTS
Diabetic individuals exhibited advanced age, a higher BMI, and increased severity of illness based on their ASA grade and CCI index. Intraoperatively, diabetic individuals showed higher probabilities of empyema of the GB (23.3%), thick wall gallbladder (3.8%), mucocele (8.3%), gangrenous (10.8%), and other complications. The model explained variability in outcomes such as severe complications (6.6%), intraoperative hemorrhages (5%), conversion to open surgery (4.2%), and length of hospital stay (1.58±1.01 SD). Persistent pain 13 (5.03%), port site infection 30 (11.6%), intraabdominal abscess 5 (1.9%), bile duct injury 8 (3.1%), jaundice 8 (3.1%), and readmission to the hospital 4 (1.5%) were noted.
CONCLUSION
Diabetic individuals undergoing laparoscopic cholecystectomy present distinct clinical features and higher probabilities of specific intraoperative and postoperative complications. The multivariate analysis provides insights into the variability of outcomes, emphasizing the importance of tailored approaches for diabetic patients in this surgical context.

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Author Biographies

Gohar Ali, Hayatabad Medical Complex, Peshawar

Resident Surgeon,
General Surgery Department,
Hayatabad Medical Complex, Peshawar

Yousaf Jan, Hayatabad Medical Complex, Peshawar, Pakistan

Associate Professor,
General Surgery Department,
Hayatabad Medical Complex, Peshawar, Pakistan

Almas Khattak, Hayatabad Medical Complex, Peshawar

Resident Surgeon,
General Surgery Department,
Hayatabad Medical Complex, Peshawar

Jawad Ali, Hayatabad Medical Complex, Peshawar

Resident Surgeon,
General Surgery Department,
Hayatabad Medical Complex, Peshawar

Muhammad Kashif Dawar, Hayatabad Medical Complex, Peshawar

Resident Surgeon,
Hayatabad Medical Complex, Peshawar

Anees Ahmad, Hayatabad Medical Complex, Peshawar

Resident Surgeon,
General Surgery Department,
Hayatabad Medical Complex, Peshawar

Fazal Ullah, Hayatabad Medical Complex, Peshawar

Resident Surgeon,
General Surgery Department,
Hayatabad Medical Complex, Peshawar

References

Portincasa P, Di Ciaula A, de Bari O, Garruti G, Palmieri VO, Wang DQH. Management of gallstones and its related complications. Expert Rev Gastroenterol Hepatol. 2016;10(1):93–112. DOI: https://doi.org/10.1586/17474124.2016.1109445

Pagliarulo M. Gallstone disease and related risk factors in a large cohort of diabetic patients. Digestive and Liver Disease. 2004 Feb;36(2):130-4. DOI: https://doi.org/10.1016/j.dld.2003.10.007

ADRIANO, ADOLFO, STEFANO, EMANUELE, ALESSANDRO, CARLO, et al. Gallstones and Diabetes: A Case-Control Study in a Free-Living Population Sample.

Noel RA, Braun DK, Patterson RE, Bloomgren GL. Increased Risk of Acute Pancreatitis and Biliary Disease Observed in Patients With Type 2 Diabetes: A retrospective cohort study. Diabetes Care. 2009 Feb 10;32(5):834–8. DOI: https://doi.org/10.2337/dc08-1755

Elmehdawi R, Elmajberi S, Behieh A, Elramli A. Prevalence of Gall Bladder Stones among Type 2 Diabetic Patients in Benghazi Libya: A Case-control Study. Libyan J Med. 2009 Mar 1;4(1):27–30. DOI: https://doi.org/10.3402/ljm.v4i1.4801

ABDULKADIR BEDIRLI. Laparoscopic Cholecystectomy for Symptomatic Gallstones in Diabetic Patients | Journal of Laparoendoscopic & Advanced Surgical Techniques. [cited 2023 Mar 25].doi:10.1089/109264201317054564 DOI: https://doi.org/10.1089/109264201317054564

Ikard RW. Gallstones, cholecystitis and diabetes. Surg Gynecol Obstet. 1990 Dec;171(6):528–32.

Shpitz B, Sigal A, Kaufman Z, Dinbar A. Acute cholecystitis in diabetic patients. Am Surg. 1995 Nov 1;61(11):964–7

Serban D, Balasescu SA, Alius C, Balalau C, Sabau AD, Badiu CD, et al. Clinical and therapeutic features of acute cholecystitis in diabetic patients. Exp Ther Med. 2021 Jul;22(1):758. DOI: https://doi.org/10.3892/etm.2021.10190

Patiño JF, Quintero GA. Asymptomatic cholelithiasis revisited. World J Surg. 1998 Nov;22(11):1119–24 DOI: https://doi.org/10.1007/s002689900530

Łącka M. Acute cholecystitis in patients with diabetes mellitus – systematic review. EUROPEAN JOURNAL OF TRANSLATIONAL AND CLINICAL MEDICINE; 2019

McIntyre C, Johnston A, Foley D, Lawler J, Bucholc M, Flanagan L, et al. Readmission to hospital following laparoscopic cholecystectomy: a meta-analysis. Anaesthesiol Intensive Ther. 2020;52(1):47–55 DOI: https://doi.org/10.5114/ait.2020.92967

Louis S. RESULTS OF GALLBLADDER SURGERY IN DIABETES MELLITUS HAROLD E. EISELE, M.D. 118(1)

Yousfani ZA, Das K, Atta J, Rind G, Khatti SN, Zoya M. Frequency of Clinical Symptoms in Post Cholecystectomy Syndrome Patients our Hospital Experience: A Cross-Sectional Study. PJMHS. 2022 Jan 31;16(1):1425–7 DOI: https://doi.org/10.53350/pjmhs221611425

Ikard RW. Gallstones, cholecystitis and diabetes. Surg Gynecol Obstet. 1990 Dec 1;171(6):528–32

Cleveland Clinic. [cited 2024 Jan 26]. What You Need To Know About Gallstones

Aune D, Vatten LJ. Diabetes mellitus and the risk of gallbladder disease: A systematic review and meta-analysis of prospective studies. J Diabetes Complications. 2016 Mar;30(2):368–73 DOI: https://doi.org/10.1016/j.jdiacomp.2015.11.012

Al-Mulhim AA. Male gender is not a risk factor for the outcome of laparoscopic cholecystectomy: a single surgeon experience. Saudi J Gastroenterol. 2008 Apr;14(2):73–9 DOI: https://doi.org/10.4103/1319-3767.39622

Corradi MB de S, D`Ávila R, Duim E, Rodrigues CIS. Risk stratification for complications of laparoscopic cholecystectomy based on associations with sociodemographic and clinical variables in a public hospital. The American Journal of Surgery. 2020 Apr 1;219(4):645–50 DOI: https://doi.org/10.1016/j.amjsurg.2019.05.005

Karamanos E, Sivrikoz E, Beale E, Chan L, Inaba K, Demetriades D. Effect of Diabetes on Outcomes in Patients Undergoing Emergent Cholecystectomy for Acute Cholecystitis. World J Surg. 2013 Oct;37(10):2257–64 DOI: https://doi.org/10.1007/s00268-013-2086-6

Terho PM, Leppäniemi AK, Mentula PJ. Laparoscopic cholecystectomy for acute calculous cholecystitis: a retrospective study assessing risk factors for conversion and complications. World J Emerg Surg. 2016;11:54 DOI: https://doi.org/10.1186/s13017-016-0111-4

Tandon A, Sunderland G, Nunes Q, Misra N, Shrotri M. Day case laparoscopic cholecystectomy in patients with high BMI: Experience from a UK centre. Ann R Coll Surg Engl. 2016 May;98(5):329–33 DOI: https://doi.org/10.1308/rcsann.2016.0125

Shirinov ZT, Aliev YG, Gamidova NA, Mekhtizade SM, Akhmedov DS. Diagnosis and surgical treatment of acute destructive calculous cholecystitis in advanced age patients]. Khirurgiia (Mosk). 2021;(6):24–9 DOI: https://doi.org/10.17116/hirurgia202106124

Bourikian S, Anand RJ, Aboutanos M, Wolfe LG, Ferrada P. Risk factors for acute gangrenous cholecystitis in emergency general surgery patients. The American Journal of Surgery. 2015 Oct;210(4):730–3 DOI: https://doi.org/10.1016/j.amjsurg.2015.05.003

Ihász M, Hung CM, Regöly-Mérei J, Fazekas T, Bátorfi J, Bálint A, et al. Complications of laparoscopic cholecystectomy in Hungary: a multicentre study of 13,833 patients. Eur J Surg. 1997 Apr;163(4):267–74

Trondsen E, Ruud TE, Nilsen BH, Mårvik R, Myrvold HE, Buanes T, et al. Complications during the introduction of laparoscopic cholecystectomy in Norway. A prospective multicentre study in seven hospitals. Eur J Surg. 1994 Mar;160(3):145–51

Z'graggen K, Wehrli H, Metzger A, Buehler M, Frei E, Klaiber C. Complications of laparoscopic cholecystectomy in Switzerland. A prospective 3-year study of 10,174 patients. Swiss Association of Laparoscopic and Thoracoscopic Surgery. Surg Endosc. 1998 Nov;12(11):1303–10 DOI: https://doi.org/10.1007/s004649900846

Al-Mulhim ARS. The Outcome of Laparoscopic Cholecystectomy in Diabetic Patients: A Prospective Study. Journal of Laparoendoscopic & Advanced Surgical Techniques. 2010 Jun;20(5):417–20 DOI: https://doi.org/10.1089/lap.2009.0436

Luthra A, Behura A, Behera CR, Mishra A, Mohanty S, Panda B. Intraoperative Findings of Elective Laparoscopic Cholecystectomy in Diabetics Versus Non-diabetics: A Comparative Study. Cureus. 2022 Jan 3 [cited 2023 Mar 24]; DOI: https://doi.org/10.7759/cureus.20886

Saleem S, Weissman S, Gonzalez H, Rojas PG, Inayat F, Alshati A, et al. Post-cholecystectomy syndrome: a retrospective study analysing the associated demographics, aetiology, and healthcare utilization. Translational Gastroenterology and Hepatology. 2021 Oct 25 [cited 2023 Dec 25];6(0) DOI: https://doi.org/10.21037/tgh.2019.11.08

Zackria R, Lopez RA. Postcholecystectomy Syndrome. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Dec 25]

Jaunoo SS, Mohandas S, Almond LM. Postcholecystectomy syndrome (PCS). International Journal of Surgery. 2010 Jan 1;8(1):15–7. DOI: https://doi.org/10.1016/j.ijsu.2009.10.008

Łącka M, Obłój P, Spychalski P, Łaski D, Rostkowska O, Wieszczy P, et al. Clinical presentation and outcomes of cholecystectomy for acute cholecystitis in patients with diabetes - A matched pair analysis. A pilot study. Advances in Medical Sciences. 2020 Sep;65(2):409–14 DOI: https://doi.org/10.1016/j.advms.2020.08.001

Moga D, Perişanu Ștefan, Popenţiu A, Sora D, Magdu H, -. Right Retroperitoneal and Subhepatic Abscess; Late Complications Due to Spilled Stones During Laparoscopic Cholecystectomy - Case Report. Chirurgia (Bucur). 2016;111(1):67–70

Thurley PD, Dhingsa R. Laparoscopic Cholecystectomy: Postoperative Imaging. American Journal of Roentgenology. 2008 Sep;191(3):794–801 DOI: https://doi.org/10.2214/AJR.07.3485

Lang X, Li L, Li Y, Feng X. Effect of Diabetes on Wound Healing: A Bibliometrics and Visual Analysis. JMDH. 2024 Mar 20;17:1275–89 DOI: https://doi.org/10.2147/JMDH.S457498

Mieczkowski M, Mrozikiewicz-Rakowska B, Kowara M, Kleibert M, Czupryniak L. The Problem of Wound Healing in Diabetes—From Molecular Pathways to the Design of an Animal Model. Int J Mol Sci. 2022 Jul 19;23(14):7930 DOI: https://doi.org/10.3390/ijms23147930

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Published

2024-12-31

How to Cite

Ali, G., Jan, Y., Khattak, A., Ali, J., Dawar, M. K., Ahmad, A. ., & Fazal Ullah. (2024). Impact of Diabetes on Outcomes of Laparoscopic Cholecystectomy: A Prospective Study. Journal of Gandhara Medical and Dental Science, 12(1), 36–42. https://doi.org/10.37762/jgmds.12-1.634