title: Delayed diagnosis of malignant tumors missed at laparoscopic cholecystectomy.
abstract: BACKGROUND
  The aim of this study was to compare the significance of routine examinations prior to laparoscopic cholecystectomy (LC) with intraoperative abdominal investigation. Preoperative evaluation becomes increasingly important when laparoscopic procedures are performed for the removal of gallstones because other intraabdominal diseases may coexist in these patients, mimicking biliary tract disease.
  
  
  METHODS
  Over the last 6 years, we treated 816 patients with symptomatic cholecystolithiasis using LC. Prior to surgery, routine tests such as upper abdominal ultrasonography, chest radiography, and standard laboratory blood tests were carried out.
  
  
  RESULTS
  Despite these routine tests, coexisting colonic cancers escaped detection in four out of 816 cases. This indicates a risk of more "missed pathologies" during the course of laparoscopic operations compared to standard laparotomy.
  
  
  CONCLUSIONS
  The risk of missing coexisting diseases during laparoscopic operations has to be minimized by placing additional emphasis on careful evaluation of anamnesis. Physical examination and additional laboratory tests--such as analysis of tumor markers and blood in the stool--combined with complete abdominal ultrasonography, gastroscopy, and/or complete colonoscopy should be performed prior to LC.
authors.affiliation: Second Surgical Department, Landeskrankenanstalten Salzburg, Austria.
authors.forename: W
authors.initials: W
authors.lastname: Junger
authors.forename: W G
authors.initials: WG
authors.lastname: Junger
authors.forename: J
authors.initials: J
authors.lastname: Hutter
authors.forename: K
authors.initials: K
authors.lastname: Miller
authors.forename: E
authors.initials: E
authors.lastname: Moritz
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000175:diagnosis*; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002769:Cholelithiasis / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D003110:Colonic Neoplasms / Q000150:complications / Q000175:diagnosis*; D003113:Colonoscopy; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged