Laparoscopic versus open cholecystectomy in diabetic patients and postoperative outcome.
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.
Paajanen
Hannu
H
Department of Surgery, Kuopio University Hospital, Kuopio, Finland. hannu.paajanen@kuh.fi
Suuronen
Satu
S
Nordstrom
Pia
P
Miettinen
Pekka
P
Niskanen
Leo
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy / Q000379:methods* / Q000706:statistics & numerical data / Q000639:trends; D017081:Cholecystectomy, Laparoscopic / Q000706:statistics & numerical data / Q000639:trends; D002764:Cholecystitis / Q000150:complications / Q000601:surgery; D002769:Cholelithiasis / Q000150:complications / Q000601:surgery*; D015897:Comorbidity; D016208:Databases, Factual; D048909:Diabetes Complications / Q000097:blood / Q000601:surgery*; D004630:Emergencies; D005260:Female; D006801:Humans; D007813:Laparotomy / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D015983:Selection Bias; D016896:Treatment Outcome