Should most asymptomatic gallstones in otherwise healthy diabetic patients be treated with elective cholecystectomy?
—Robert E. Hollis Jr, MD, Fort Mitchell, Ky.
Gallstones are more common in diabetic patients than in others, and there is some largely anecdotal evidence that diabetics are at increased risk for developing severe gangrenous cholecystitis. This information led some authorities in the 1980s to recommend prophylactic cholecystectomy for asymptomatic patients. However, the risk of gangrenous cholecystitis is small and probably doesn’t outweigh the risks and costs associated with surgery. One study, for example, showed that of 47 diabetic patients found to have asymptomatic gallstones, only 14% went on to have symptoms or complications from cholelithiasis at five years (Dig Dis Sci. 1994;39:1704-1707), similar to data from the general population. Consequently, most authorities no longer recommend prophylactic cholecystectomy for asymptomatic diabetic patients.
—Daniel G. Tobin, MD (110-8)