Laparoscopic cholecystectomy: potential for missed pathology

The performance of a general exploratory laparotomy immediately after opening the abdominal cavity has long been a foundation of surgical practice. Since the introduction of laparoscopy, this procedure has been modified. This may result in certain intra-abdominal pathologies being overlooked, especially in areas that are hard to observe with the laparoscope. In this paper we describe two patients who presented with carcinomas after uneventful laparoscopic procedures, one of the lower oesophagus and the other of the pancreas. This raises questions about the extent of preoperative investigation before the performance of laparoscopic procedures.