LAPAROSCOPIC CHOLECYSTECTOMY - RISK OF MISSED PATHOLOGY OF OTHER ORGANS

Background: The wide acceptance of laparoscopic cholecystectomy (LC) h as resulted in increased rates of cholecystectomy. However, the increa sed rate of LC bears the possibility of concomitantly missing other in tra-abdominal pathologic states that exist concurrently with this proc edure. The purpose of this report was to evaluate data on LC with rega rd to missed pathologies of other organs in a clinical prospective fol low-up. Methods: The clinical prospective follow-up of 676 patients tr eated laparoscopically for gallstone disease at our unit since January 1993, was studied. Converted procedures were excluded from the follow -up study. Results: Among 676 patients who underwent LC, 4 patients (0 .6%) required readmission for missed pathology of another organ. The d iagnostic delay ranged from 2 weeks to 7 months. The readmissions were due to colonic cancer (2 cases), carcinoma of the stomach (1 case), a nd fibrosis of the mesenterium of small bowel causing ileus (1 case), which are demonstrated in detail. According to retrospective analysis of the symptoms, none of the patients had typical biliary pain at the time of laparoscopic procedure. Conclusions: The demand for LC from pa tients and practitioners is becoming increasingly more frequent, as al l become aware of its benefits, However, on the basis of data from the literature and this study, the authors would like to emphasize the ne ed for careful history-taking, thorough investigation, and comparison with gallstone symptoms before LC is performed. It is emphasized, howe ver, that surgeons using laparoscopic approaches should learn techniqu es of full diagnostic laparoscopy, which should be performed at the be ginning of every procedure.