Biliary surgery in diabetic patients: Statistical analysis of 189 patients

Biliary tract disease and diabetes mellitus are considered to be ominously associated with high mortality and morbidity. The present report deals with 1, 500 consecutive biliary procedures and compares the data of 189 diabetic patients (DP) with that of 1, 311 nondiabetics (NDP). A wide data base was considered in both categories studied, and all data were computer-analyzed. The most significant results were as follows: (1) in the DP Group there was a higher incidence of patients above 60; (2) a larger percentage of DP were operated upon under emergency conditions (35 vs. 23%, p = 0.01; acute cholecystitis, septic cholangitis). (3) There was a higher rate of DP with septic bile (61 vs. 27%, p = 0.001) and a higher incidence of septic complications (usually wound infection) in the diabetic patients; (4) the mortality rate of DP was not significantly higher in elective cases; however, there was a significant difference in mortality in acute cases (3.1 vs. 1.1%, p = 0.05). The main conclusions are: (1) A very low mortality rate (2.1%) was achieved in diabetic patients undergoing surgery for acute cholecystitis and cholangitis, and it seems that the policy of early and definitive surgery adopted has contributed to the good results. (2) There is no significant difference between diabetic and nondiabetic patients with regard to elective surgery for cholelithiasis. (3) This study supports the view that cholelithiasis and its complications are very common in diabetic patients above the age of 50. Sonographic screening for gallstones in such populations seems useful. An epidemiological study of biliary compli-cations in diabetics is being conducted at present by the authors.