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PubMed2001

Surgical trainees' attitudes to laparoscopic cholecystectomy: a regional survey.

BACKGROUND AND STUDY AIMS: Since the introduction of laparoscopic cholecystectomy (LC), numerous articles have been written emphasising its many advantages over open cholecystectomy (OC). However, reports also highlight increased complications following LC such as bile-duct, vascular and bowel injuries. We aimed to study surgical trainees as a defined population of individuals who, with increasing exposure to cholecystectomy, would become fully aware of LC's advantages and controversies. We wished to test the hypothesis that, with increasing in-depth knowledge, they might opt for OC rather than LC if they themselves required cholecystectomy. MATERIALS AND METHODS: We conducted a postal survey of all 133 Northern Ireland surgical trainees identified as having exposure to LC during their training. Trainees were asked whether they would undergo LC and if so with which preconditions. Similarly, if they stated a preference for open cholecystectomy they were asked to state the reason. A minimum time period of 18 months was considered adequate for trainees to become relatively more experienced in this field compared with their more junior counterparts. RESULTS: A response rate of 80.5% (107/133) was achieved. A total of 51 of 107 trainees had at least 18 months' experience. Of the 107 who replied, 88.8% (95/107) would be willing to undergo LC. A total of 12 of 107 trainees would opt for OC, with twice as many experienced trainees (8 vs. 4) opting for this approach (n.s. [not significant]). Significantly more experienced trainees cited the use of laparoscopic cholangiography as a precondition for LC compared with their inexperienced counterparts (7 vs. 1, p = 0.020). Of 107 trainees, 19 would request use of the open first port (Hasson) technique; 14 of these had at least 18 months' experience (p = 0.009). CONCLUSION: Our survey confirms that the majority of trainees would be willing to undergo LC. However, increased experience of LC may alter an individual's expectations about how LC should ideally be performed.

Adult↗
PubMed1992

Long-term follow-up after laparoscopic cholecystectomy.

A five-year follow-up was performed in 93 of 94 patients who successfully underwent laparoscopic cholecystectomy between 1985 and 1987. The results were compared to those in 130 of 136 patients of a non-randomized control group who had undergone open cholecystectomy during the same period. Patients characteristics and gallbladder findings were comparable in the two groups. Postoperative complications were infrequent and not significantly different in the two groups, whereas the mean hospital stay was shorter in the laparoscopic group. During follow-up, one patient in the laparoscopically treated group had a common bile duct stone which was treated surgically since he refused to undergo ERCP; this patient died of postoperative complications. Various abdominal complaints were reported in 27% and 25% of the patients undergoing laparoscopic and open cholecystectomy, respectively; in most cases no organic causes were found. Scar problems were less frequently reported in the laparoscopically treated group (2% versus 12%). It is concluded that the long-term results of laparoscopic cholecystectomy are as good as those of open cholecystectomy, however, the hospital stay is significantly shorter and the long-term cosmetic results are considerably better in laparoscopically treated patients.

Cholecystectomy↗
PubMed2000

A comparison of laparoscopic and open cholecystectomy in patients with compensated cirrhosis and symptomatic gallstone disease.

BACKGROUND: The purpose of this study was to compare the risks and benefits of performing open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) in patients with compensated cirrhosis. METHODS: Data on 50 patients who underwent cholecystectomy for the treatment of symptomatic gallstone disease between 1990 and 1997 were collected retrospectively. These patients were divided into 2 groups: Group I included 24 patients who underwent OC, and Group II included 26 patients who underwent LC. The cohorts were well-matched for age, sex, race, clinical presentation, and Child-Turcotte-Pugh (CTP) class. Twelve patients in Group I had a concomitant surgical procedure in contrast to only 2 patients in Group II. No patient in this study had CTP Class C cirrhosis. RESULTS: There was no operative mortality. Conversion to OC was necessary in 3 patients (12%) during LC because of uncontrollable liver bed bleeding in 2 of the patients and insufficient visualization of the anatomy in 1 of the patients. Mean surgical times were significantly longer in Group I when comparing patients from both groups without concomitant surgical procedures (mean +/- SD, 177 +/- 91.3 minutes vs 116.8 +/- 42.3 minutes, P = .037). No patient in Group II required any blood component replacement in contrast to 9 patients (38%) in Group I. Intraoperative bleeding remained significantly higher in Group I when comparing patients without concomitant surgical procedures (P = .043). No patients in Group II had a wound complication, compared with 2 patients (8%) in Group I. The 12 patients without concomitant surgical procedures in Group I had significantly longer hospital stays when compared with 24 patients without concomitant surgical procedures in Group II (mean +/- SD, 6.9 days +/- 3.3 [median 6] vs 2.4 days +/- 1.8 [median 2.0]); P = .001. CONCLUSIONS: Our results demonstrate that laparoscopic cholecystectomy can be performed safely in patients with CTP Class A and B cirrhosis. It offers several advantages over open cholecystectomy, including lower morbidity, shorter operative time, and reduced hospital stay with less need for transfusions.

Blood Loss, Surgical↗
PubMed2005

Oxidative stress markers after laparoscopic and open cholecystectomy.

BACKGROUND: Surgical injury is associated with oxidative stress, often due to ischemia/reperfusion injury. During laparoscopy, increased intra-abdominal pressure caused by pneumoperitoneum may cause splanchnic ischemia followed by reperfusion due to deflation. We measured several markers of oxidative stress in patients undergoing laparoscopic cholecystectomy (LC) versus open cholecystectomy (OC) to find if these surgical procedures result in different patterns of oxidative stress. METHODS: This prospective study enrolled 43 patients with symptomatic cholelithiasis, of whom 21 underwent open, and 22 laparoscopic, cholecystectomy. Twenty healthy adults comprised the control group. Total antioxidant status (TAS), superoxide dismutase (SOD), endogenous peroxide level (POX), oxidized low density lipoprotein (oLDL) autoantibodies (oLAb), and neopterin were measured preoperatively and on postoperative days 1, 3, and 7. RESULTS: POX values decreased significantly on postoperative day 1 in the OC (P<0.01), but not in the LC, group. On postoperative day 7, POX values were higher than preoperatively in both groups (P<0.01) with no difference between the LC and OC groups. Significant postoperative elevations of oLAb and neopterin levels were observed only on postoperative day 7 in the OC group. There were no changes of oLAb and neopterin levels in the LC group. TAS and SOD levels did not change after either LC or OC. CONCLUSION: Cholecystectomy, either open or laparoscopic, caused only moderate oxidative stress. Open cholecystectomy caused changes of oLAb and neopterin, suggesting more severe oxidative stress, and a possible role of reactive oxygen species in the healing of the laparotomic wound.

Adult↗
PubMed2006

Intra-abdominal adhesions after open and laparoscopic cholecystectomy: an experimental model.

PURPOSE: To evaluate the incidence of intra-abdominal adherences after open and laparoscopic cholecystectomy, on the basis of an experimental study in pigs. MATERIALS AND METHODS: A total of 40 female pigs, mean weight 25 kg, underwent open cholecystectomy by right subcostal laparotomy (group A, n = 22) or laparoscopic cholecystectomy using a Storz laparoscope (group B, n = 18). After surgery, the abdominal wall was closed with polydioxanone suture and staples (group A) or with staples only (group B). One month later, the pigs underwent medial laparotomy to assess whether intra-abdominal adherences had developed. Incidences were compared between groups by the chi-square test with Yates correction. RESULTS: Five pigs in group A and one pig in group B died within 24 hours of surgery, leaving 17 pigs in each group. Mean operative time was similar for both groups (24.7 minutes in group A, 25.3 minutes in group B). In group A, 16 pigs (94%) developed intra-abdominal adherences, in all cases multiple; in group B, only 9 pigs (53%) developed adherences, and in 8 of these pigs only a single adherence was present (P < 0.03). CONCLUSIONS: The results of this study indicate that the incidence of intra-abdominal adherences is statistical lower after laparoscopic cholecystectomy than after open cholecystectomy.

Animals↗
PubMed1994

Is previous abdominal surgery a contraindication to laparoscopic cholecystectomy?

Previous abdominal surgery has been reported as a relative contraindication to laparoscopic cholecystectomy. An analysis of 193 laparoscopic cholecystectomies was undertaken to determine whether this relative contraindication led to increased morbidity, an increased rate of conversion to open cholecystectomy, or longer operating time. The results of 55 patients who had previous abdominal surgery were compared with those of 138 patients without previous abdominal surgery. Morbidity, conversion rate, and operating time were not increased in patients with previous abdominal surgery. We found both previous upper and previous lower abdominal surgery to be risk for laparoscopic cholecystectomy. Laparoscopic cholecystectomy can be performed safely in patients with previous abdominal surgery if we (1) use the cutdown technique initially, (2) dissect the adhesion before the upper midline port is inserted, (3) retrogradely dissect the gallbladder from the liver bed, and (4) divide the cystic artery and duct last.

Abdomen↗
PubMed1994

Timing of laparoscopic cholecystectomy in acute cholecystitis.

Laparoscopic cholecystectomy was performed in 467 patients between November 1989 and April 1991. Fifty-four patients (12%) had acute inflammatory changes. These were divided into three different groups: group 1-13 patients who admitted having an attack of right upper quadrant pain within 24-48 h of their scheduled elective laparoscopic cholecystectomy; group 2-23 patients who had a history of acute cholecystitis treated 4-6 weeks before their elective laparoscopic cholecystectomy; group 3-18 patients who were admitted to the hospital and were diagnosed with acute cholecystitis; they had laparoscopic cholecystectomy performed in the same admission. All patients had a successful laparoscopic removal of their gallbladder except 2 in group 3 who had to be converted to an open procedure. Analysis of the operative time, complications, and hospital stay showed that after adequate experience is gained in performing laparoscopic cholecystectomy, acute cholecystitis is not a contraindication. The procedure is faster and safer if performed in the first 24-48 h of the onset of the symptoms. Different technical maneuvers are needed due to the nature of the disease.

Acute Disease↗
PubMed1995

Impact of laparoscopic technique on the quality of cholecystectomy.

To compare the quality of cholecystectomy before and after the introduction of laparoscopic technique, a comparison was made between 463 consecutive patients undergoing open cholecystectomy (OC) during the 1985-1989 and 329 consecutive patients cholecystectomized during 1991-1993 after the introduction of laparoscopic cholecystectomy (LC) (i.e., open or laparoscopic cholecystectomies). The frequency of procedure-related complications was unchanged in the two periods [13 vs. 9% (NS)], but general complications were reduced from 17 to 9% (p < 0.001), mainly attributable to a reduced incidence of pulmonary complications. Mortality was 2.2 and 0.9%, respectively (NS). The frequency of bile duct injury was 0.2% in the first and 0.6% in the second period (NS). The frequency of reoperations was 2.8 and 1.8% (NS), and residual stones were later detected in 3.0 and 3.6%, respectively (NS). Hospital stay after elective surgery was reduced from 6 days in the first period to 4 days in the second (all cases) (p < 0.001). Thus the quality of cholecystectomy improved regarding general complications, while mortality and number of reoperations were unchanged. Further improvement is desirable to prevent general as well as procedure-related complications.

Aged↗
PubMed1995

Laparoscopic cholecystectomy does not prevent the postoperative protein catabolic response in muscle.

OBJECTIVE: The authors determined the effect of laparoscopic cholecystectomy on protein synthesis in skeletal muscle. In addition to a decrease in muscle protein synthesis, after open cholecystectomy, the authors previously demonstrated a decrease in insulin sensitivity. This study on patients undergoing laparoscopic and open surgery, therefore, included simultaneous measurements of protein synthesis and insulin sensitivity. SUMMARY BACKGROUND DATA: Laparoscopy has become a routine technique for several operations because of postoperative benefits that allow rapid recovery. However, its effect on postoperative protein catabolism has not been characterized. Conventional laparotomy induces a drop in muscle protein synthesis, whereas degradation is unaffected. METHODS: Patients were randomized to laparoscopic or open cholecystectomy, and the rate of protein synthesis in skeletal muscle was determined 24 hours postoperatively by the flooding technique using L-(2H5)phenylalanine, during a hyperinsulinemic normoglycemic clamp to assess insulin sensitivity. RESULTS: The protein synthesis rate decreased by 28% (1.77 +/- 0.11%/day vs. 1.26 +/- 0.08%/day, p < 0.01) in the laparoscopic group and by 20% (1.97 +/- 0.15%/day vs. 1.57 +/- 0.15%/day, p < 0.01) in the open cholecystectomy group. In contrast, the fall in insulin sensitivity after surgery was lower with laparoscopic (22 +/- 2%) compared with open surgery (49 +/- 5%). CONCLUSIONS: Laparoscopic cholecystectomy did not avoid a substantial decline in muscle protein synthesis, despite improved insulin sensitivity. The change in the two parameters occurred independently, indicating different mechanisms controlling insulin sensitivity and muscle protein synthesis.

Adult↗
PubMed1996

Recovery of fasted and fed gastrointestinal motility after open versus laparoscopic cholecystectomy in dogs.

OBJECTIVE: The authors investigate the recovery of gastrointestinal motility in the fed and fasted state after laparoscopic and open cholecystectomy. SUMMARY BACKGROUND DATA: Clinical recovery after laparoscopic cholecystectomy is known to be more rapid than after conventional open cholecystectomy. However, the actual effect of a laparoscopic approach on gastrointestinal motility, particularly fed-state motility, is not well investigated. METHODS: Laparoscopic (LAP, n=6) or open (OPEN, n=6) cholecystectomy was performed in 12 dogs. Bipolar recording electrodes were placed on the antrum, small intestine, and the transverse and descending colon, and fasting myoelectric data were recorded after operation. Solid meal gastric emptying studies were performed before surgery and on postoperative days 1 and 2. Transit time studies were performed using 10 radiopaque markers. RESULTS: Gastric emptying was significantly delayed in the OPEN group at 120 minutes on postoperative day 1 compared with pre-operative emptying (p<0.05), but was not delayed on postoperative day 2. Gastric emptying was not delayed in the LAP group after operation. Transit time was the same between groups. Gastric dysrhythmias were more frequent on postoperative day 3 (p<0.05) in the OPEN group. There were no significant differences in the presence, cycle length, or propagation velocity of the migrating motor complex on any postoperative day. Discrete or continuous electrical response activity in the colon was observed by postoperative day 1 in both groups. CONCLUSIONS: Fed-state motility is the only parameter for which laparoscopic cholecystectomy showed an improvement in postoperative recovery. Recovery of fasted gastrointestinal motility in dogs is equally rapid after either operation.

Animals↗
PubMed1999

Complications of cholecystectomy: risks of the laparoscopic approach and protective effects of operative cholangiography: a population-based study.

BACKGROUND: Previous studies suggest that laparoscopic cholecystectomy (LC) is associated with an increased risk of intraoperative injury involving the bile ducts, bowel, and vascular structures compared with open cholecystectomy (OC). Population-based studies are required to estimate the magnitude of the increased risk, to determine whether this is changing over time, and to identify ways by which this might be reduced. METHODS: Suspected cases of intraoperative injury associated with cholecystectomy in Western Australia in the period 1988 to 1994 were identified from routinely collected hospital statistical records and lists of persons undergoing postoperative endoscopic retrograde cholangiopancreatography. The case records of suspect cases were reviewed to confirm the nature and site of injury. Ordinal logistic regression was used to estimate the risk of injury associated with LC compared with OC after adjusting for confounding factors. RESULTS: After the introduction of LC in 1991, the proportion of all cholecystectomy cases with intraoperative injury increased from 0.67% in 1988-90 to 1.33% in 1993-94. Similar relative increases were observed in bile duct injuries, major bile leaks, and other injuries to bowel or vascular structures. Increases in intraoperative injury were observed in both LC and OC. After adjustment for age, gender, hospital type, severity of disease, intraoperative cholangiography, and calendar period, the odds ratio for intraoperative injury in LC compared with OC was 1.79. Operative cholangiography significantly reduced the risk of injury. CONCLUSION: Operative cholangiography has a protective effect for complications of cholecystectomy. Compared with OC, LC carries a nearly twofold higher risk of major bile, vascular, and bowel complications. Further study is required to determine the extent to which potentially preventable factors contribute to this risk.

Aged↗
PubMed1993

Pulmonary function after laparoscopic cholecystectomy.

BACKGROUND: The purpose of this study was to prospectively compare the effect of laparoscopic cholecystectomy (LC) versus open cholecystectomy (OC) on postoperative pulmonary function. METHODS: Forty consecutive patients (20 in each group) who were evenly matched in terms of pulmonary risk factors were assigned to either elective LC or OC. Pulmonary function studies, oxygen saturation, and chest radiography were performed on both groups before and after the operation until baseline levels were reached. Narcotic requirements and pulmonary complications were compared. The t test, ANOVA, and chi-squared analysis were used. RESULTS: Compared to the patients who underwent OC, patients who underwent LC had a significant reduction in postoperative pulmonary impairment (30% to 38%) in all areas studied including forced vital capacity; forced expiratory volume in 1 second; forced expiratory flow, mid-expiratory phase; maximum forced expiratory flow; maximum voluntary ventilation; total lung capacity; and oxygen saturation. Pulmonary function returned to baseline levels 4 to 10 days sooner after LC. Pulmonary complications including atelectasis and hypoxia were less frequent after LC. An eight-fold decrease was noted in postoperative pain medication requirement in the LC group. CONCLUSIONS: Compared to OC, laparoscopic cholecystectomy results in a significantly reduced compromise in pulmonary function and narcotic requirement leading to fewer postoperative pulmonary complications. Laparoscopic cholecystectomy should be considered the procedure of choice for elective cholecystectomy.

Adolescent↗
PubMed1996

Laparoscopic cholecystectomy: the experience of community hospital.

BACKGROUND: The practice of laparoscopic cholecystectomy in a community hospital is presented. The morbidity of the procedure is analysed and recommendations for improvement are made. Laparoscopic cholecystectomy was introduced into this 200 bed community hospital in October 1990. All five general surgeons accredited to the hospital agreed to participate in a quality assurance programme to determine the incidence of complications and to make recommendations for improvement. METHODS: The records of all 534 patients having laparoscopic cholecystectomy between October 1990 and September 1993 were reviewed, and all complications recorded. RESULTS: Of the 534 cases reviewed in the study 470 were considered uncomplicated and 64 patients experienced a total of 85 postoperative complications. The death of one patient was caused by a pulmonary embolus and another patient experienced a myocardial infarction. Twenty patients has postoperative atelectasis or pneumonia and urinary infection or retention occurred in seven. Complications of laparoscopic cholecystectomy requiring a conversion to open cholecystectomy occurred in eight patients, biliary complications occurred in 18 and 11 required re-operation. CONCLUSIONS: Three areas of concern were identified. They were the incidence of major biliary injury (0.37% of all cases) and its management, the role of cholangiography, and the incidence and prophylaxis of deep venous thrombosis and pulmonary embolism. Recommendations for improvement in these areas were made.

Australia↗
PubMed1994

Complications after laparoscopic and conventional cholecystectomy: a comparative study.

The growing popularity of laparoscopic cholecystectomy (LC) has made extensive series comparing laparoscopic and conventional cholecystectomy in a prospective, randomized way nearly impossible. To evaluate LC we compared retrospectively 800 laparoscopic with 748 conventional cholecystectomies (CC). Of the 800 LC, 10 (1.2%) were converted to laparotomy. 6 conversions were related to aberrant anatomical features or features making dissection very difficult, 4 conversions were due to complications. There were 5 (0.6%) intraoperative complications during LC and 4 (0.5%) during CC. Postoperative morbidity was 2.1% (n = 17) after LC and 3.7% (n = 28) after CC. Particularly the incidence of wound problems was only 0.5% (n = 4) after LC while it was 1.3% (n = 10) after CC. Overall morbidity was 2.7% (n = 22) for LC and 4.2% (n = 32) for CC. Mortality rate after CC was 0.4% (n = 3), there were no deaths after LC. Common bile duct-injury rate was 0.2% (n = 2) for both groups. Complication rates after LC have been rapidly decreasing with growing experience. Laparoscopic cholecystectomy can safely be performed by appropriately trained surgeons in more than 90% of patients suffering from gallbladder disease. The low morbidity and mortality together with the significant advantages to patient recovery makes laparoscopic cholecystectomy the treatment of choice for symptomatic cholecystolithiasis.

Adolescent↗
PubMed1993

Laparoscopic cholecystectomy: anesthetic implications.

Laparoscopic cholecystectomy is a relatively new surgical procedure, enjoying ever-increasing popularity and presenting new anesthetic challenges. The advantages of shorter hospital stay and more rapid return to normal activities are combined with less pain associated with the small limited incisions and less postoperative ileus compared with the traditional open cholecystectomy. Complications are mostly due to traumatic injuries sustained during blind trocar insertion, and physiologic changes associated with patient positioning and pneumoperitoneum creation. The choice of anesthetic technique for laparoscopic cholecystectomy is limited most frequently to general anesthesia. Controlled ventilation avoids hypercarbia, and an anesthetic technique incorporating antiemetics and nonsteroidal antiinflammatory agents has reduced postoperative nausea and vomiting. The use of nitrous oxide and narcotics during laparoscopic cholecystectomy is controversial. Laparoscopic cholecystectomy is a major advance in the management of patients with symptomatic gallbladder disease. However, in the present era of cost containment, older and sicker patients may present for this procedure on the day of surgery without adequate preoperative evaluation. Anesthesiologists thus should be prepared to recommend conversion to an open procedure if hemodynamic, oxygenation, or ventilation difficulties occur during the procedure.

Anesthesia↗
PubMed1999

Open and laparoscopic cholecystectomy in acquired immunodeficiency syndrome: indications and results in fifty-three patients.

BACKGROUND: Although acute cholecystitis is one of the most common indications for abdominal surgery in patients with acquired immunodeficiency syndrome (AIDS), previous studies have reported disappointingly high morbidity and mortality among those patients who have undergone cholecystectomy. The aims of this study were to analyze the indications for and the outcome of cholecystectomy performed for acute cholecystitis in patients with AIDS. METHODS: We retrospectively reviewed the hospital charts of 53 patients with AIDS who underwent open or laparoscopic cholecystectomy from 1992 to 1997. Statistical analysis using the chi-square, Student's t, and Fisher exact tests was conducted to determine whether cause of cholecystitis, type of surgical approach, and CD4+ T-lymphocyte count influenced outcome. RESULTS: The clinical findings and imaging by ultrasonography were always reliable in establishing diagnosis and guiding treatment of acute cholecystitis. Open cholecystectomy was performed in 24 patients (45%). The procedure was begun laparoscopically in 29 patients (55%) and converted to open in 4 (14%). The pathologic findings showed acalculous cholecystitis in 19 patients (36%) and cholelithiasis in 32 (60%). Morbidity was 34% and mortality was 2%. Type of operative approach, cause of cholecystitis, and CD4+ T-lymphocyte count (greater or less than 50 cells/mm3) did not significantly affect morbidity and mortality. The length of hospital stay was significantly influenced by the CD4+ T-lymphocyte count. CONCLUSIONS: These findings suggest that in most patients with AIDS, laparoscopic or open cholecystectomy may be performed with significant but acceptable morbidity and low mortality.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Spirometric evaluation of external respiration function in laparoscopic and mini-laparotomy cholecystectomy].

Spirometric parameters are studied in 54 patients subjected to laparoscopic cholecystectomy and cholecystectomy through a mini-laparotomy approach. The restrictive and obstructive disorders in the external respiratory function after minilaparotomy cholecystectomy are less expressed than after laparoscopic cholecystectomy. Thorough examination of the external respiratory function is recommended when defining the indications for laparoscopic cholecystectomy.

Adolescent↗
PubMedDate not supplied

Gallbladder carcinoma during laparoscopic cholecystectomy: is it associated with bad prognosis?

Laparoscopic cholecystectomy is the treatment of choice for gallstone disease. The ultrasonogram has failed for the early detection of gallbladder cancer, especially if inflammation (chronic or acute) is present. Incidental gallbladder could be an important cancer finding during laparoscopic cholecystectomy, due to the potential cancer cell dissemination during the procedure. In our Department, 6500 laparoscopic cholecystectomies have been performed in the last 5 years and in 15 cases (0.23%) gallbladder cancer was found during surgery or after histological examination of the resected gallbladder. In none of these 15 patients was pre-operative diagnosis of gallbladder carcinoma postulated. When re-evaluation of the pre-operative ultrasonograms was done, it was possible to observe signs suggesting the presence of neoplastic infiltration in 4 of them (28.6%). During videoscopic exploration, also in 4 patients, the suspicion of gallbladder cancer was noted. Laparoscopic cholecystectomy was completed in 9 patients. In 2 of them, in situ or mucosal invasion was demonstrated with a long survival. One patient presented recurrence at the biliary hilum 2,5 years after surgery. Six patients were re-operated and in 4 of them peritoneal or port site metastasis was found; all died early (4.5 month median survival). The other 2 patients were submitted to liver bed resection and lymph node dissection. These patients are free of cancer recurrence after 15 months of follow-up. Six patients were converted to open surgery, performing palliative procedures and died before the 12 month follow-up. The suspicion of pre-operative gallbladder cancer is generally unlikely to be confirmed based on ultrasonographic signs; but, in some cases with high suspicion, further investigation (TAC, tumor markers, etc.) must be indicated in order to avoid poor results. Laparoscopic cholecystectomy could be associated with bad prognosis, and then, when gallbladder cancer is suspected during the laparoscopic procedure, conversion to open surgery could be the best choice.

Carcinoma↗