MISSED PATHOLOGY FOLLOWING LAPAROSCOPIC CHOLECYSTECTOMY - A CAUSE FORCONCERN

Although many have recorded the incidence of complications after lapar oscopic cholecystectomy, few have discussed the possibility of missing intra-abdominal pathology after this procedure. We have evaluated the first two years, September 1990-September 1992, of laparoscopic chole cystectomy in our community. Readmissions within 10 months of the orig inal surgery with another diagnosis similar to gallbladder disease wer e considered ''missed pathology'' at the original surgical procedure. For the first 12-month period, 465 laparoscopic cholecystectomies were performed. Seventy-seven patients were readmitted, with 13 of these p atients having other intra-abdominal pathology. These readmissions wer e for carcinoma (6), inflammatory bowel disease (2), diverticular dise ase, esophageal varices, and appendicitis. In the second year 429 lapa roscopic cholecystectomies were performed; 59 patients were readmitted , with 10 of these patients having other intra-abdominal pathology. Th ese readmissions were for carcinoma (3), inflammatory bowel disease (2 ), strongyloides, peptic ulcer disease, and abdominal pain of unknown etiology (3). Although intra-abdominal pathology was found in only 2%- 5% of all patients having surgery for gallbladder disease, of the pati ents who were readmitted for ''missed pathology,'' 46% the first year and 30% the second year were readmitted for carcinomas. Several other diseases were found in patients whose symptoms mimicked gallbladder di sease. It is therefore possible that in the zeal to perform a new proc edure, other diagnoses may be overlooked.