To compare the intraoperative difficulties faced in Laparoscopic cholecystectomy in diabetic versus non diabetic patients

Manjot kaur; Naveed anjum qureshi; Anshuman chander; Ankush kaul

Volume : VII, Issue : IX, September - 2017

To compare the intraoperative difficulties faced in Laparoscopic cholecystectomy in diabetic versus non diabetic patients

Manjot Kaur, Naveed Anjum Qureshi, Anshuman Chander, Ankush Kaul

Abstract :

Aim and objectives: – To compare the intraoperative difficulties faced in Laparoscopic cholecystectomy in diabetic versus non diabetic patients. MATERIALS AND METHODS–The present prospective study included ultrasonographically proved 300 patients of symptomatic cholelithiasis, operated as elective cases in district hospital, burali, Punjab. The patients were selected randomly. Relevant history, clinical examination and investigations were recorded including random blood sugar. Surgery was performed by the consultant of a single unit. The diabetic mellitus patient were defined according to the WHO Diabetes Diagnostic Criteria. Two groups were made for the study purpose–group 1– included patients with gall stone disease with diabetes mellitus and group 2 included patients with gall stone disease without diabetes mellitus (the control group).Difficulty during Laparoscopic Cholecystectomy was assessed using preoperative (USG abdomen, previous attacks, total leucocyte count) and intraoperative measures (conversion rate, identification of Calot’s anatomy, time taken, bile spillage, injury to vascular and ductal structures).RESULTS AND CONCLUSION– Out of total 300 patients, 217 were females and 83 were men.117 patients were diabetic and 183 were nondiabetic/controls. Out of 117 diabetic patients, 83 were females and 34 were men. In the control group, 110 were females and 73 were males. The mean operation time was 81 minutes in control group and the postoperative hospital stay ranged to 5.4 (1–18) days. No conversion rate was reported in control group. In diabetic group only in 3 patients it was not possible to apply the "critical view of safety" resulting in a conversion to open cholecystectomy. The mean operation time was 120 minutes in diabetic group and the postoperative hospital stay ranged to 11 days .Postoperatively an insufficiency of cystic duct, a navel infection, an abdominal wall hematoma, an urinary tract infection and a pneumonia occurred in 10 patients each of diabetic group. A bile duct injury was reported in one patient of diabetic group. Hence it can be concluded that Diabetes mellitus not only increases the incidence of gall bladder disease in patients but also increases the difficulty of operating during Laparoscopic cholecystectomy