36 J Gandhara Med Dent Sci
January - March 2025
:
:
ORIGINAL ARTICLE
IMPACT OF DIABETES ON OUTCOMES OF LAPAROSCOPIC CHOLECYSTECTOMY: A
PROSPECTIVE STUDY
Gohar Ali1, Yousaf Jan2, Almas Khattak3, Jawad Ali4, Muhammad Kashif Dawar5, Anees Ahmed6, Fazal Ullah7
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
ndings, 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 specic 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.
KEYWORDS: Diabetes, Intraoperative Findings, Complications,
Laparoscopic Cholecystectomy
How to cite this article
Ali G, Jan Y, Khattak A, Ali J, Dawar
MK, Ahmed A, etal. Impact of
Diabetes on Outcomes of
Laparoscopic Cholecystectomy: A
Prospective Study. J Gandhara Med
Dent Sci. 2024;12(1):36-42.doi:10.37762
Date of Submission: 17-11-2024
Date Revised: 04-12-2024
Date Acceptance: 19-12-2024
1Resident Surgeon, General Surgery
Department, Hayatabad Medical
Complex, Peshawar
3Resident Surgeon, General Surgery
Department, Hayatabad Medical
Complex, Peshawar
4Resident Surgeon, General Surgery
Department, Hayatabad Medical
Complex, Peshawar
5Resident Surgeon, Hayatabad Medical
Complex, Peshawar
6Resident Surgeon, General Surgery
Department, Hayatabad Medical
Complex, Peshawar
7Resident Surgeon, General Surgery
Department, Hayatabad Medical
Complex, Peshawar
Correspondence
2Yousaf Jan, Associate Professor,
General Surgery Department,
Hayatabad Medical Complex,
Peshawar, Pakistan
+92-333-9279312
dr.yousaf.shinwari@gmail.com
INTRODUCTION
Gallstone disease is a prevalent global health concern,
with substantial associated management costs and
potential complications. The relationship between
cholelithiasis and diabetes mellitus (DM) has garnered
significant attention, with numerous studies suggesting
a higher prevalence of gallbladder disease in
individuals with DM.1,2,3 In people with diabetes, GB
function is altered compared to those without diabetes.
The main problem for diabetic patients is a functional
deficit caused by unclear factors, leading to a larger and
less ecient organ.4,5 These patients often have higher
levels of bile acid and lipids, causing obesity,
dyslipidemia, type 2 diabetes, hyperinsulinemia,
hypertriglyceridemia, and metabolic syndrome. They
also tend to have more bacteria in the bile and are more
prone to infections than non-diabetic individuals.1,2
Specifically, gallbladder inammation (cholecystitis) is
more severe in diabetic patients, with more serious
illnesses and faster disease progression.6,7,8 Diabetes is
also a factor that increases the chances of problems
before and after surgery.5,6 Fortunately, careful
preparation before surgery and improvements in
surgical techniques have shown promise in making
outcomes similar for people with and without
diabetes.6,7 some experts suggest that diabetic patients
with gallstones who show no symptoms should
8,9
consider having prophylactic cholecystectomy. Some
reports suggest early cholecystectomy for diabetic
patients to prevent serious complications because of the
perceived surgical risks and high postoperative
complications associated with diabetes.6,10,11 While
some studies suggest higher rates of morbidity and
/jgmds.12-1.631
37
J Gandhara Med Dent Sci
January - March 2025
mortality in diabetic individuals undergoing
Laparoscopic Cholecystectomy, others propose
prophylactic or early cholecystectomy to mitigate
complications. Despite these observations, there
remains a gap in our understanding of how diabetes
inuences outcomes in LC for gallbladder
diseases.7,10,11,12 Uncontrolled diabetes has been shown
to correlate with a higher incidence of emergency
cholecystectomy, intraoperative complications,
conversions from laparoscopic to open
cholecystectomy, and less favorable overall outcomes
when contrasted with outcomes in non-diabetic
individuals.4,12,13,14,15 The study aims to determine
whether diabetes signicantly aects patient outcomes
in laparoscopic cholecystectomy (LC) done for
gallbladder diseases. The goal is to carefully compare
these outcomes with those of individuals without
diabetes to know the risks associated with diabetes in
this situation. To uncover signicant disparities in
clinical features and outcomes between diabetic and
non-diabetic groups and to identify complications and
improve management of diabetics.
METHODOLOGY
this study was done in the General Surgical unit of
Hayatabad medical complex Peshawar, Pakistan, from
Jan 2023 to Jan 2024 after ethical approval from the
ethical committee of Hayatabad medical complex. The
study encompassed all patients undergoing elective
Laparoscopic Cholecystectomy who were diagnosed
with gallbladder stones during the study period. After
strict inclusion criteria, 258 patients were included in
the study. Forty-eight patients were excluded based on
exclusion criteria. Written and informed consent was
obtained from each patient. Under a standardized
proforma, patient’s preoperative, intraoperative, and
postoperative data were collected. Each patient was
followed for 1 month to collecpostoperative data.
Proforma included demographic details, body mass
index (BMI), preoperative signs and symptoms, history
of pancreatitis or cholecystitis, diabetes control with
oral or insulin (or both), or uncontrolled. Tokyo grades
of cholecystitis, ASA (American society of
anesthesiologists) score, Charlson Comorbidity Index
(CCI), ultrasound ndings, blood tests, intraoperative
findings, and postoperative follow-up information.
Patients underwent echocardiography and lung function
tests based on their situations. Once the patient was
prepared, general anesthesia was given, and sterile
draping was applied. Four ports were strategically
placed, including a camera allbports Based on
intraoperative observations, the cystic duct and artery
were tied and cut to release and retrieve the gallbladder.
A drain was inserted when needed, and the ports were
removed. The patient recovered well from anesthesia
and was moved to postoperative care. Consultants did
Consultants did all the surgeries. surgery-related
complications like intraoperative hemorrhage, bile leak
into the peritoneum, conversion to open surgery, length
of post-op stay, length of total hospital stay, total
operative time taken, and severe complications like
anesthesia, death, shift to the ICU, AKI, stroke, and MI
were noted. During of follow-up or a a 1-month:
persistent pain, port site infection (umbilical port or
epigastric port site), bile duct injury, intra-abdominal
abscess, jaundice, or common bile duct injury, and
readmissions were noted. The data underwent statistical
analysis and p-value (with signicance set at p < 0.05)
to ensure data validity. The inclusion criteria were
gallbladder stones, mild cholecystitis (TOKYO grade 1)
whereas acalculous cholecystitis, GB malignancy,
pregnancy, acute pancreatitis, cholangitis,
choledocholithiasis, loss of follow-up, moderate or
severe cholecystitis were excluded. statistical analyses
to compare results among the mentioned data.
Descriptive analysis involved using medians, means,
and standard deviations. Associations between dierent
variables were evaluated using the Pearson chi-square
or Fisher's exact test and the t-test. Relative risk and
odds ratio were calculated for diabetic vs. non-diabetic
patients regarding major complications and surgery-
related complications. For comparing preoperative
characteristics, Pearson’s Chi-square or Fisher’s exact
test was used for categorical variables, and the Mann-
Whitney u-test independent sample t-test and Kruskal-
Walli’s test were used for continuous variables, as
appropriate. Univariate and multivariate analyses were
employed to assess variable features and complications
for each study group, adjusting for signicant factors
identified at p < 0.05 in the analysis. Adjusted odds
ratios with 95% condence intervals were derived from
the multivariate analysis. Sub-features of the dependent
variable diabetes were analyzed using the t-test, chi-
square test, and univariate and multivariate analysis.
Data were entered and analyzed using the Statistical
Package for Social Sciences (SPSS), version 23.0.
RESULTS
258 patients were included in our study, consisting of
60 (23.3%) diabetics and 198 (77.1%) non-diabetics.
Regarding age, diabetic individuals had a slightly
higher mean age of 45.18 ± 11.81 years compared to
non-diabetic individuals, who had a mean age of 42.02
± 12.93 years. No signicant dierences among age
groups. Gender distribution revealed that 35.6% of
diabetic participants were male, while 64.3% were
female. In the non-diabetic group, 22.8% were male and
77.1% were female. No signicant diere nces were
observed between genders. Analysis of Body Mass
Index (BMI) indicated that diabetic individuals had a
significantly higher mean BMI (30.17 ± 6.73) compared
to non-diabetic individuals (25.93 ± 4.32). Diabetic
Impact of Diabetes on Outcomes of Laparoscopic Cholecytectomy
38 J Gandhara Med Dent Sci
January - March 2025
individuals demonstrated a higher ASA grade,
indicating a greater severity of illness, with signicant
differences observed in ASA grade categories. Further
categorizing ASA grade into <3 Or three or >3, it was
noted that 92.63% of diabetic individuals had ASA
grade <3, whereas 75% of non-diabetic individuals fell
into this category, which was statistically signicant
(Table 1). The Charlson Comorbidity Index (CCI)
showed diabetic individuals having a signicantly
higher mean CCI index (2.11 ± 1.26) compared to non-
diabetic individuals (0.33 ± 0.71). These ndings have
implications for LC outcomes in further study.
Regarding symptoms, pain in the right hypochondrium
(RHC) was not signicantly higher in people with
diabetes 9 (1.5%) compared to non-diabetics 28
(4.57%) (p = 0.112). Nausea or vomiting was more
prevalent in people with people with diabetes (18.33%)
than in non-diabetics (1.52%) (p = 0.000). Murphey’s
sign positivity was signicantly higher in people with
diabetes (25%) compared to non-diabetics (1.01%) (p =
0.000). In summary, there are signicant dierences
between diabetic and non-diabetic groups in terms of
nausea/vomiting, Murphey's sign positivity, and
generalized abdominal pain (Table 1). Also, signicant
dierences were observed in ultrasound ndings and
WBC counts between diabetic and non-diabetic groups.
(Table 1) People with diabetes had a signicantly
higher incidence of empyema of GB (23.3% vs. 0.5%),
thick wall GB (3.8% vs. 7%), and gangrenous GB (30%
vs. 4.5%) compared to non-diabetics. People with
diabetes also had longer total operative time (102.66
minutes vs. 44.7 minutes), a signicant dierence.
Intraoperative hemorrhages (5% vs. 0%), bile leaks
from GB (56.6% vs. 2.02%), and more extended
hospital stays were signicantly higher in people with
diabetes. Diabetes had a higher conversion rate to open
surgery (11.6% vs. 2.0%). Persistent pain (20% vs.
6%), port-site infection (31.1% vs. 5.5%), intra-
abdominal abscess (8.3% vs. 0%), bile ducts injury
(8.3% vs. 1.51%), and jaundice (8.3% vs. 1.51%) were
significantly higher in diabetes. Readmission rates were
similar between diabetics and non-diabetics (3.39% vs.
1.5%). (Table 2).
Table 1: Demographic Prole, Clinical Features, and Ultrasound & Lab Findings of Study Population
Variables Overall (n = 258) Diabetics (n = 60) Non-diabetics (n = 198) p-value (CI 95%)
Age in years (mean ± SD) 42.75 ± 12.73 45.18 ± 11.81 42.02 ± 12.93 0.043 t*
Age Groups
(years)
18-29 47 (18.2%) 05 (8.3%) 42 (21.2%)
30-39 72 (27.9%) 18 (30%) 54 (27.3%)
40-49 60 (23.3%) 14 (23.3%) 46 (23.2%)
50-59 43 (16.7%) 14 (23.3%) 29 (14.6%)
60-70 36 (14.0%) 09 (15%) 27 (13.6%) 0.222 b
Gender Male 92 (35.6%) 21 (22.8%) 71 (77.1%)
Female 166 (64.3%) 39 (23.5%) 127 (76.5%) 0.749 b
BMI (mean ± SD) 26.98 ± 5.28 30.17 ± 6.73 25.93 ± 4.32 0.000 t*
Comorbiditi
es
COPD 01 (0.38%) 0 (0%) 01 (0.5%) 0.191 b
Hypertension 44 (17.0%) 11 (18.3%) 33 (16.6%) 0.97 b
Past hx of upper GI surgery 03 (1.16%) 02 (3.3%) 01 (0.5%) 0.201 b
Past hx of cholecystitis 37 (14.3%) 26 (43.3%) 11 (5.5%) 0.000 b*
Past hx of pancreatitis 22 (8.52%) 15 (25%) 07 (3.53%) 0.000 b*
ASA Grade (mean ± SD) 1.41 ± 0.69 0.000 t*
ASA Grade 1 177 (68.60%) 10 (16.67%) 166 (84.34%)
ASA Grade 2 62 (24.03%) 35 (58.33%) 27 (13.64%)
ASA Grade 3 13 (5.04%) 11 (18.33%) 02 (1.01%)
ASA Grade 4 06 (2.33%) 04 (6.67%) 02 (1.01%)
ASA Grade <3 239 (92.63%) 45 (75%) 194 (97.9%) 0.001 b* (5.12-51.03)
ASA Grade ≥3 19 (7.4%) 15 (25%) 04 (2.1%)
Clinical
Features
Pain RHC 37 (14.34%) 09 (15%) 28 (14.57%) 0.112 b
Nausea/vomiting 14 (5.43%) 11 (18.33%) 03 (1.52%) 0.000 b*
Murphey's sign positive 17 (6.59%) 15 (25%) 02 (1.01%) 0.000 b*
Palpable mass in RHC 02 (0.78%) 01 (1.67%) 01 (0.51%) 0.661
Generalized abdominal
pain 06 (2.33%) 05 (8.33%) 01 (0.51%) 0.002 b*
Ultrasound
Findings
Pericholecystic edema
present 24 (9.3%) 21 (35%) 03 (1.51%) 0.000 b*
GB wall thickness > 3mm 54 (20.9%) 37 (61.6%) 17 (8.58%) 0.000 b*
<10k 222 (86%) 37 (61%) 185 (93.4%)
>10k 36 (13.9%) 23 (38%) 12 (6.06%) 0.000 b*
WBC (mean ± SD) 8567.87 ± 3007 75.8 ± 14.81 68.51 ± 10.9 0.022 t*
Serum
Creatinine >2 mg/dl 0 (0%) 0 (0%) 0 (0%) -
Impact of Diabetes on Outcomes of Laparoscopic Cholecytectomy
t = Mann Whitney U test / independent sample t-test, b = Chi-square test. * = statistically signicant, SD = standard
deviation.
39
J Gandhara Med Dent Sci
January - March 2025
Table 2: Comparison of Intraoperative and Postoperative Characteristics
Features
intraoperative
Over all
n(%) Diabetics Non-
Diabetics
Univariate
P
Univariate odd
(CI 95%)
Multivariate
p
Multivari
ate odd
(CI 95%)
Empyema of GB 15(5.8%) 14(23.3%) 1(0.5%) 0.000 0.233(0.179-
0.288) 0.000 2.40(0.17
9-0.288)
Anatomic anomaly 08(3.1%) 04(6.6%) 04(2%) 0.088 0.574(0.528-0.62) 0.000 0.574(.07
4-0.159)
Thick wall GB 37(14.34%) 23(3.8%) 14(7%) 0.000 15.13(14.9-15.37) 0.000 53.6(.519t
o 0.648)
Adhesions
Soft adhesions
Dense adhesions
16(6.2%)
15(5.8%)
12(20%)
15(25%)
04(20%)
0(0%)
0.000
53.68(53.269-
54.109)
0.000 15.13(.99
3-1.207)
Mucocele 5(1.93%) 05(8.3%) 0(0%) 0.000 0.320(0.238-
0.402) 0.000 0.32(.04-
0.117)
Gangrenous GB 27(10.4%) 18(30%) 09(4.5%) 0.000 9.116(7.242-
10.98) 0.000 9.11(.387-
0.513)
Iatrogenic
injury(CBD,gut,ves
sels, stomatch,)
17(6.5%) 17(28.3%) 0(0%) 0.000 3.7(2.499-4.895) 0.000 3.69(.228-
.339)
Bleeding from GB
bed 37(14.3%) 23(38.3%) 14(7.07%) 0.000 21.28(20.50-
22.054) 0.000 21.27(.63
5-0.765)
Rupture of GB 43(16.6%) 39(65%) 04(2.02%) 0.000 21.27(0.635 to
0.765) 0.000 18.264(.5
83-0.717)
Total operative time
in mins((mean±SD))
58.18±1.98
102.66±34.38
44.7±13.7
0.001
na(97.47-107.8)
0.011
Na (97.57-
107.85)
Impact of Diabetes on Outcomes of Laparoscopic Cholecytectomy
Outcomes and
complications after
surgery during same
admission
Overall Diabetics Non-
diabetics
Univ
ariate
P
Univariate odd
(CI 95%) variate
p
Multivariate
odd (CI 95%)
Intraoperative
hemorrhages cystic
artery laceration
03(1.16%) 03(5%) 0(0%) 0.001 0.115(0.019-
0.081)
0.000 0.115(.023-
0.077)
Leak of bile for GB 38(14.7%) 34(56.6%) 04(2.02%) 0.001 13.75(0.498-
0.625)
0.000 13.75(.498-
0.635)
Length of hospital
stay (mean±SD)
1.58±1.01 2.56±1.44 1.28±0.58 0.000 75.8(2.34-2.78) 0.001 75.9(2.34-2.78)
Post op hospital stay
in days(mean±SD))
0.78±1.17 1.86±1.5 0.45±0.8 0.000 91.82(1.61-2.12)
0.000 91.82(1.61-2.12)
Conversion to open
surgery
11(4.2%) 07(11.6%) 04(2.0%) 0.001 1.28(0.121-0.213)
0.000 1.279(.121-0.213)
Severe complications (during post op to 1 month)
Anesthesia complication 06(2.3%) 04(6.6%) 02(1.01%) 0.11 2.062(0.164-0.27)
0.51 Na
AKI 03(1.16%) 02(3.3%) 0
Cardiac ie MI 0 0 0
Shift to icu 0 01(1.6%) 0
Stroke 02(0.77%) 01(1.6%) 01(0.5%)
Death 01(0.38%) 0 01(0.5%)
Persistent pain (PCS) 24(9.3%) 12(20%) 12(6%) 0.001 5.58(0.308-0.449)
0.000 6.589(.321-0.445)
Por site infection 030(11.6%)
19(31.3%) 11(5.5%) 0.000 7.85(0.34-0.491)
0.000 7.859(.365-0.502)
Intraabdominal abscess
05(1.9%) 05(8.3%) 0 0.001 2.878(0.19-0.311)
0.000 2.878(.197-0.303)
08(3.1%) 05(8.3%) 03(1.51%) 0.001 1.28(0.121-0.213)
0.000 1.279(.121-0.213)
Jaundice 08(3.1%) 05(8.3%) 03(1.51%) 0.000 0.82(0.091-0.175)
0.000 0.819(.091-0.175)
Readmission to hospital
04(1.5%) 02(3.39%) 02(1.5%) 0.111 1.3(0.01-0.03) 0.61 1.1(0.022-0.06)
Bile ducts injury
Multi
"na" means not available
Table 2B: Comparison of Postoperative Characteristics
40 J Gandhara Med Dent Sci
January - March 2025
DISCUSSION
Our study aims to determine the interaction between
diabetes and gallstone disease management by
examining the clinical features, intraoperative variables,
and postoperative outcomes in diabetic and non-
diabetic individuals. Signicantly, diabetic patients in
our study displayed a higher mean age than non-
diabetic patients. This age disparity raises questions
about the potential role of aging as a predisposing
factor for gallstone formation in diabetic individuals,
supported by previous studies such as the Cleveland
Clinic, Dragos Serban et al., and dagnn Aune et
al.9,16,17 while gender distribution across both groups
suggests gender-specic considerations in
understanding gallstone disease, our ndings dier
from Abdulmohsen et al. and Monika Laka et al.11,18
Our study showed a notable prevalence in the non-
diabetic group compared to the person with diabetes of
prior upper GI surgery, prompting reection on the
impact of prior surgical interventions on the trajectory
of gallstone disease. A similar study by Matheus
Bartolomei de Siqueira et al.19 Moreover, past episodes
of cholecystitis and pancreatitis were more frequent in
the diabetic groups, consistent with existing literature,
further highlighting the heightened risk associated with
diabetes in these conditions. Similar research was
conducted by Karamanos Efstathios et al., Serbon
Dragos et al., Monika and Laka et al., Petra Maria et al.,
Noel RA et al., and Dagnn Aune et al.4,9,11,17,20,21 BMI
emerged as a crucial determinant in our study,
emphasizing the intricate relationship between
adiposity and gallstone pathophysiology, which aligns
with previous ndings by Tandon et al.22 Our study
revealed signicant and frequent intraoperative adverse
findings in diabetic patients compared to non-diabetics,
corroborating similar ndings in previous studies. Our
study’s ndings align with those of Abdulkadir Bedril
et al., Karamonas et al., Shirinov et al., and Bourikian et
al. reinforcing the signicance of our results in the
context of cholecystectomy in diabetic patients. These
findings underscore the importance of meticulous
surgical management for diabetic patients undergoing
LC.6,20,23,24 Conversion to open surgery rates were
higher in diabetic patients, 7 (11.6%) vs. 4 (2.0%),
highlighting the need for careful consideration and
preparedness for potential complications during
laparoscopic procedures. Although multi-institutional
studies have indicated average conversion rates ranging
from 5.3% to 8.2% in similar patient populations,
ABDUL KADIR BEDIRLI et al., Ihász and Hung et al.,
Trondsen et al. and Z'graggen et al. (6,25–27). Total
operative time was prolonged in diabetic patients in our
study, consistent with ndings by Al-Mulhim et al. and
Luthra Ashish et al., emphasizing the need for ecient
surgical techniques in this patient population. (28,29).
Diabetic patients experienced more extended hospital
stays (2.56 ± 1.44) and increased rates of postoperative
complications (1.86 ± 1.5) compared to non-diabetics
(0.45 ± 0.8), reecting the complex clinical course
associated with diabetes in the context of LC, similar
findings reported by Al-Mulhim et al.28 Early
postoperative outcomes showed a notable absence of
mortality in diabetic patients, consistent with some
studies but contrasting with others, suggesting the need
for further investigation into factors contributing to
postoperative mortality in diabetic populations. Our
study, consistent with Łącka et al., Dragos Serban et al.,
and Louis St. et al., found no mortality among diabetic
patients, contrasting with Patiño et al.’s
findings.9,11,13. Follow-Up Postoperative Outcomes:
Persistent pain and port-site infections were more
prevalent in diabetic patients in our study, aligning with
findings from previous studies and emphasizing the
importance of vigilant postoperative care in this
population. Yousfani et al., Saleem Saad et al., Zackria
et al. and Jaunoo et al.14,30,31,32 Port site infections were
more prevalent among diabetic patients in our study,
with over 30 cases identied, aligning with the ndings
of Monika et al., who reported a surgical site infection
rate out of 11.6%, 19( 7.3%) in people with diabetes
compared to 11(4.2%) in the control group.33 Deep
infections or intra-abdominal abscesses were
exclusively observed in diabetic patients in our study,
highlighting the need for proactive measures to prevent
such complications in diabetic individuals undergoing
LC. Nonetheless, a case report by Doru Moga et al.
highlighted increased stone spillage during LC as a
potential cause of deep-site infections. In our study, we
also observed more spillage in people with diabetes.34
Bile duct injury and jaundice-related complications
were more frequent in diabetic patients, underscoring
the importance of careful surgical technique and
postoperative monitoring in this population. In
literature, Thurley et al. report that surgical
complications, notably bile duct complications,
accounted for a signicant portion of reasons for
readmission, with no specic studies comparing
diabetic and non-diabetic bile duct injuries.35
Hyperglycemia impairs wound healing and immune
function by reducing blood circulation and
oxygenation, decreasing leukocyte migration,
suppressing immune responses, and prolonging
inammation. These eects hinder infection control
and delay recovery by limiting nutrient delivery and
impairing red and white blood cell function. These
mechanisms may explain the increased rates of surgical
site infections, prolonged inammation, and delayed
recovery observed in diabetic patients undergoing
LC.36,37 Our study sheds light on the complex interplay
between diabetes and non-diabetic having gallstone
disease, providing valuable insights into the clinical
Impact of Diabetes on Outcomes of Laparoscopic Cholecytectomy
41
J Gandhara Med Dent Sci
January - March 2025
features, intraoperative variables, and postoperative
outcomes associated with LC in diabetic patients. These
findings underscore the importance of tailored
diagnosis, surgical management, and postoperative care
approaches in diabetic populations to optimize
outcomes and minimize complications. Further research
is warranted to elucidate the underlying mechanisms
driving the observed disparities and inform evidence-
based strategies for managing gallstone disease in
diabetic individuals. By addressing these factors,
clinicians emphasize the need for customized surgical
and perioperative approaches to improve care for
diabetics.
LIMITATIONS
Firstly, we could not compare blood glucose values and
HbA1c levels between the diabetic and non-diabetic
groups due to the unavailability of this data in our
dataset. This is because glycated hemoglobin is not
routinely measured in acute admissions at our
institution. Additionally, the diagnosis of diabetes in
our study was based on retrospective data, which may
have led to bias. Some patients may have been
diagnosed with diabetes after their cholecystectomy, as
our database did not show real-time changes in
diagnosis. Furthermore, our study did not match
patients based on comorbidities, which could have
inuenced our results.
CONCLUSIONS
In this study, we meticulously examined the impact of
diabetes on LC outcomes for gallstone disease. We
found distinct clinical proles in diabetic patients, with
higher comorbidity rates and increased intraoperative
challenges, such as a greater need for conversion to
open surgery. Postoperatively, diabetic patients
experienced prolonged hospital stays and higher
complication rates. These ndings highlight the need
for tailored management strategies in this population.
Future research should focus on prospective, multi-
center studies to validate these ndings and optimize
care for diabetic patients undergoing LC.
CONFLICT OF INTEREST: None
FUNDING SOURCES: None
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CONTRIBUTORS
1. Gohar Ali - Concept & Design; Data Acquisition; Data
Analysis/Interpretation; Drafting Manuscript
2. Yousaf Jan - Drafting Manuscript; Critical Revision;
Supervision; Final Approval
3. Almas Khattak - Data Acquisition; Critical Revision
4. Jawad Ali - Data Acquisition
5. Muhammad Kashif Dawar - Data Acquisition
6. Anees Ahmad - Data Acquisition
7. Fazal Ullah - Data Acquisition
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Impact of Diabetes on Outcomes of Laparoscopic Cholecytectomy
