Missed malignancies during laparoscopic cholecystectomy

BACKGROUND/AIMS: Laparoscopic cholecystectomy is now the treatment of choic e for symptomatic gallstone diseases. However, besides its great benefits, perhaps the most disappointing complication of this operation is missed mal ignancies. In this study, patients who had missed malignancies that were di agnosed shortly after laparoscopic cholecystectomy were studied. We aim to find out the cause of missed and delayed diagnosis. METHODOLOGY: Between 1991 and June 1997, 9 patients undergoing laparoscopic cholecystectomy, which had been performed elsewhere 2-9 months earlier, an d having had missed malignancy were included in this study. A diagnostic su rvey was collected from the medical records, questionnaires, and a semiolog ical analysis. All laboratory data and physical findings, before and after laparoscopic cholecystectomy, were recorded. Follow-up data were obtained t hrough a telephone questionnaire. RESULTS: Of these 9 patients, 6 had colorectal carcinoma and 3 had pancreas carcinoma. All patients complained of recent atypical pain at the time of laparoscopic cholecystectomy, except for 1 patient who had no symptomatic r egression. CONCLUSIONS: It is necessary to make a careful semiological, physical and l aboratory analysis of patients with cholelithiasis before especially laparo scopic cholecystectomy. Elderly patients, atypical biliary pain and associa ted symptoms must draw attention to the possibility malignancy.