Pitfalls in laparoscopic cholecystectomy: unrecognized carcinoma of another site

Laparoscopic cholecystectomy has been rapidly adopted as a standard surgical treatment in symptomatic cholelithiasis. Its advantages over laparotomy are well described. However, its risks and long-term results have not been fully evaluated. We experienced three patients in whom intra-abdominal carcinomas failed to be recognized during laparoscopic surgery. The clinical manifestations, laboratory findings, and radiologic findings were carefully reviewed in each case. Limited exploration of the abdominal cavity is one of the technical pitfalls in laparoscopic cholecystectomy; so surgeons can miss the carcinoma of extrabiliary system. To prevent such problems, a careful taking of the history and physical examination should be repeated by the responsible surgeon, who must be aware of the differential diagnosis of cholelithiasis, especially in elderly patients. If needed, additional radiologic studies are recommended.