Biliary Surgery in Diabetic Patients: Statistical Analysis of 189 Patients

Abstract

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 complications in diabetics is being conducted at present by the authors.

Multifactorial analysis of septic bile and septic complications in biliary surgery

“…Previous reports [9][10][11][12][13][14][15][16][17][18] have shown the high association between bile flora and septic complications. In this study we analyzed our data in two aspects: 1) factors influencing the rate of Positive flora and 2) factors influencing the rate of septic complications.…”

“…It is well established that prophylactic antibiotics can reduce these complications [5][6][7][8]. Identification of patients at high risk is the subject of many investigations, and indeed, several predictors for septic complication have been identified such as: age >70 years, acute cholecystitis, diabetes mellitus, exploration of the choledochus, and positive bile cultures [7,9,10]. By establishing our new criteria for prophylaxis, taking in consideration a combination of several risk factors as guidelines to the antibiotic regimen, we hope to maintain a low rate of septic complications using a more economical and selective approach.…”

State of the Art in the Diagnosis and Management of Acute Cholecystitis

“…This type of disease (AAC -Acute Acalculous Cholecystitis) is more common in the elderly males and diabetics. Specific clinical condi tions favoring its appearance are extensive trauma, prolonged fasting, sepsis and multi ple transfusions [17][18][19].…”