MANAGEMENT OF GALLSTONES IN DIABETIC-PATIENTS

The management of gallstones in diabetic patients has traditionally be en considered problematic. Autopsy findings and uncontrolled studies h ave documented a higher prevalence of cholelithiasis in diabetics, and early reports showed dramatically increased perioperative morbidity a nd mortality for treatment of diabetics with acute cholecystitis. As a result, some authorities have recommended prophylactic cholecystectom y for diabetic patients with asymptomatic gallstones, which is in cont rast to recommendations for nondiabetics. More recent investigators ha ve shown comparable rates of operative morbidity and mortality for bil iary surgery in diabetics when compared with the general population. R ecent studies have questioned whether diabetes is an independent risk factor for gallstone formation. Decision analyses using these new data have shown that prophylactic cholecystectomy is not of clear benefit and should not be routinely recommended for diabetics with asymptomati c gallstones. We believe that available data, although limited, indica te that asymptomatic patients with diabetes do not benefit from screen ing for gallstones and that cholecystectomy should only be performed i n cases of symptomatic cholelithiasis, as is the case in the general p opulation.