Parietal seeding of carcinoma of the gallbladder after laparoscopic cholecystectomy

Abstract

We agree with Mr Widdison's comment that perineal drains can be brought out more anteriorly with a consequent reduction in postoperative discomfort of group 2 patients (undergoing primary closure of the perineum and perineal drainage).With respect to the comments of Lewis et al., our results show a longer postoperative hospital stay for group 2 patients than in their series. We do not know their rate of infection but our patients had a high rate of perineal wound infection (47 per cent) with method 2, which made partial or complete opening of the perineal wound necessary. This led to a longer hospital stay.Our patients were not randomized, although the study was done prospectively, requiring that the three series be homogeneous with respect to age, sex and histological degree of malignancy. A non-parametric test could be used for the differences in hospital stay but the statistical test used is robust and the conclusions identical with either method.

Trocar-site metastasis following laparoscopic cholecystectomy for unsuspected carcinoma of the gallbladder

“…Recent reports have also documented the occurrence of trocar-site metastasis from carcinoma of the gallbladder following laparoscopic cholecystectomy [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. Many surgeons believe that carcinoma of the gallbladder is a contraindication to laparoscopic cholecystectomy.…”

Appendiceal mucocele

“…This has led to recommendations restricting laparoscopic colonic resections for curable colorectal carcinoma to prospective studies [29] and even to strongly contraindicating laparoscopic surgery for suspected ovarian [7] and gallbladder carcinoma. [16,17,24,26]. Although many authors have advised that malignant gastrointestinal lesions should not be removed laparoscopically, we have not found any reported case of peritoneal or abdominal wall tumor seeding after laparoscopic appendectomy in the biomedical literature to date.…”

“…Scientific studies comparing curative laparoscopic and open surgery for gastrointestinal malignancies have not been completed as yet [21]. Substantial evidence of unexpected complications from laparoscopic surgery for abdominal and pelvic cancer, namely intra-abdominal and abdominal wall tumor seeding, has been widely reported in recent years [2,3,7,11,20,22,24,25]. This has led to recommendations restricting laparoscopic colonic resections for curable colorectal carcinoma to prospective studies [29] and even to strongly contraindicating laparoscopic surgery for suspected ovarian [7] and gallbladder carcinoma.…”