LESSONS DERIVING FROM AN EASY LAPAROSCOPIC CHOLECYSTECTOMY

Abstract

Gallstone is a very frequent condition, therefore laparoscopic cholecystectomy - the gold standard in the treatment of the above mentioned pathology - is the most frequent surgical intervention performed in the surgery departments in the country and abroad. At the same time, it is the laparoscopic surgery with the highest number of intraoperative incidents and accidents. Thus, in a surgical environment dominated by the stress of injuring the main bile duct, extracting the piece and sending it for the anatomical pathology examination remains on a secondary level. This is why we would like to discuss a problem related to laparoscopic cholecystectomy which is less approached in the specialty literature. Patient B, admitted to the General Surgery and Emergency Clinic III of the University Emergency Hospital of Bucharest (UESB) – medical chart (M.C.), aged 66 with a surgical history – a simple, uncomplicated laparoscopic cholecystectomy, undergone ​​two years before, with a good postoperative evolution – came to the emergency room with diffuse abdominal pain, more pronounced on the right flank. The clinical, biological and imaging evaluation performed did not reveal any pathological aspects, except for the abdominal-pelvic CT scan with a contrast agent which revealed an expansive process in the right hypochondrium lining the costal side of the liver segment VI. The tumour was surgicaly removed; the extemporaneous histopathological examination was inconclusive about the origin of the tumoral formation (adenocarcinoma of the digestive tract ). The key to the diagnosis was obtained in an administrative manner because, when the discharge letter delivered at the time of the cholecystectomy was reviewed, the absence of the result of the anatomical pathology examination of the cholecystectomy piece was noticed. The respective clinic was contacted and the result of the anatomical pathology examination was obtained, i.e. adenocarcinoma of the gallbladder. After 3 months from the surgery the patient returned with a left breast tumor with the HP diagnosis of invasive ductal carcinoma and a total Madden mastectomy wa performed. After 5 more months, surgery was necessary again for a parietal epigastic tumor - with the anatomical pathology result of cholangiocarcinoma. The author reports the case because he believes that this is further proof of the necessity of sending any cholecystectomy piece, and broadly speaking, any excised piece, for the HP examination. Moreover the patient's attention should be drawn to the necessity of returning to the clinic to take the anatomical pathology result because this result may require the reconsideration of therapeutic conduct.