Reappraisal of the management of cholelithiasis in diabetics

Abstract

Recently, dramatic advances in research have elucidated the prognosis of gallstone disease and have permitted a more selective choice of persons for treatment based on symptom status and projected prognosis. Ultrasound- detected-incidental gallstones are infrequently clinically significant, but this finding has prompted the surgeons to have a liberal attitude towards the operative indications for cholelithiasis particularly after the advent of laparoscopy. At the same time, the management of gallstones in the diabetics still remains controversial. Early retrospective studies reported an alarmingly high incidence of gallstones in diabetics as compared with the general population and in view of profound morbidity and mortality rates observed in the diabetics, prophylactic cholecystectomy was generally recommended. However, recent evidence-based studies challenged this approach and concluded that prophylactic cholecystectomy is not justified in diabetic patients with asymptomatic gallstones. It is inferred that, as in the general population, asymptomatic cholelithiasis in diabetics should be managed expectantly and preemptive surgery should not be routinely performed. However, early laparoscopic cholecystectomy is preferred in cases of symptomatic cholelithiasis.