Laparoscopic resection has become one of the choices for
colectomy for various colon and
rectal diseases in recent years. Despite some uncertainties of laparoscopic procedures, especially during
cancer surgery, its popularity has forced surgeons to pursue the approach. One of the concerns is inadequate examination of the intra-abdominal organs with a
laparoscope. This study is a retrospective analysis of a single surgeon's experience of the frequencies of unexpected findings during
laparotomies. From July 1990 to November 2005, 2775 patients with various colorectal diseases receiving
laparotomies by a single surgeon were analyzed. Among them, 2282 patients were operated for primary
colorectal cancer. Excluded were patients who did not receive a formal
laparotomy, who had a recent
laparotomy, who had peritoneal and omental
metastasis, and whose pathology did not attract attention for management. Exploration of the entire peritoneal cavity was performed for all cases in the series. There were 1423 males and 1352 females. Ages ranged from 12 to 94 years, averaging 62.6-years-old. Forty-six patients (1.7%) were found to have unexpected intra-abdominal lesions during
laparotomies. Eleven patients were found to have synchronous
colorectal cancers; five patients were found to have unexpected liver
metastases; three patients each were found to have
gastric cancers, stromal
tumors of the small bowel, and ectopic pancreas; two patients each were found to have gastric
leiomyosarcomas,
pancreatic cancers,
mucoceles of the appendix,
ulcers of the small intestine,
bleeding Meckel's
diverticula,
pancreatitis, and perforations of the ileum; one patient each was found to have
gall bladder cancer, malignant
carcinoid tumor,
pheochromocytoma,
diverticulitis of the jejunum,
diverticulitis of the colon, duplication of the colon, and
aortic aneurysm larger than 6 cm. Forty-one of the lesions were likely to be missed by
laparoscope. This experience suggests that incomplete
laparotomies might miss various pathologies. Laparoscopy is not a complete form of
laparotomy because of loss of tactile sensation. Laparoscopy might result in an inadequate or inappropriate management due to misdiagnosis.