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Gallbladder cancer is a relatively uncommon malignancy. Its presentation is similar to that of gallstone disease and sometimes with non-specific symptoms. Laparoscopic cholecystectomy has become the method of choice for removing the gallbladder in most benign conditions. Occasionally, unsuspected gallbladder carcinoma is encountered in association with laparoscopic cholecystectomy. Overall gallbladder cancers have a poor prognosis, despite surgery or adjuvant therapies. However, in selected cases, a favourable outcome can be expected and the less favourable predicted outcome can be improved. Management of patients with gallbladder cancer in different situations is discussed: gallbladder cancer noted post-operatively on final pathology, gallbladder cancer noted after removal of the gallbladder and opening of the specimen at the time of surgery, difficulty encountered at the time of dissection and resultant suspicion of gallbladder cancer, and diagnosis of extensive disease at initial placement of the laparoscope.

Gallbladder cancer is a relatively uncommon malignancy. Its presentation is similar to that of gallstone disease and sometimes with non-specific symptoms. Laparoscopic cholecystectomy has become the method of choice for removing the gallbladder in most benign conditions. Occasionally, unsuspected gallbladder carcinoma is encountered in association with laparoscopic cholecystectomy. Overall gallbladder cancers have a poor prognosis, despite surgery or adjuvant therapies. However, in selected cases, a favourable outcome can be expected and the less favourable predicted outcome can be improved. Management of patients with gallbladder cancer in different situations is discussed: gallbladder cancer noted post-operatively on final pathology, gallbladder cancer noted after removal of the gallbladder and opening of the specimen at the time of surgery, difficulty encountered at the time of dissection and resultant suspicion of gallbladder cancer, and diagnosis of extensive disease at initial placement of the laparoscope. (C) 2001 Harcourt Publishers Ltd.

Laparoscopic treatment of common bile duct (CBD) stones is gaining great acceptance worldwide, but actually it requires skills and technologies too expensive for a great part of general surgeons. So endoscopic removal of CBD stones before cholecystectomy is usually performed. Since 1991 in our department we started a policy of selective preoperative cholangiopancreatography (ERCP) in patients suspected for choledocholithiasis and waiting for laparoscopic cholecystectomy.

The aim of this study was to show that laparoscopic cholecystectomy can be performed safely without routine intraoperative cholangiography. We performed a retrospective analysis of 1750 consecutive patients (1170 females and 580 males with a mean age of 51 years) who underwent laparoscopic cholecystectomy between January 1991 and January 2000. In all, 193 patients (11%) were selected to undergo preoperative endoscopic retrograde cholangiopancreatography (ERCP) on the basis of several criteria for risk of stones. No patients underwent intraoperative cholangiography. ERCP allowed us to make a diagnosis of biliary stones in 62.7% (121 cases). Extraction of the stones was successful in 96% of the cases. In 12% of cases ERCP findings were normal; in the remaining 26.3%, useful diagnostic information was obtained. There were three complications (bleeding and pancreatitis) after endoscopy (complication rate: 1.5%). Laparoscopic cholecystectomy was successful in 92.7% of patients, with a postoperative morbidity rate of 3% (0.5% of major complications). There were no deaths in this series. During a mean follow-up of 60 months (range, 12-120), 7 patients (0.43%) were found to have residual biliary stones (5 had not had preoperative ERCP). The study confirms the hypothesis that laparoscopic cholecystectomy can be safely performed without routine intraoperative cholangiography, with selective use of preoperative ERCP.

Laparoscopic splenectomy is performed with increasing acceptance for hematologic disorders, with low complication rates reported. Splenoportal thrombosis following splenectomy is a rare complication, anecdotally reported after laparoscopic procedures. We here describe a case of thrombosis of the spleno-mesenteric-portal axis 14 days after a laparoscopic splenectomy using Ligasure. Abdominal ultrasound scans and Doppler examination allowed us to diagnose this event, and an angio-MR scan performed afterward confirmed the diagnosis. Heparin therapy was promptly begun. The patient was then switched to oral anticoagulant therapy, with resolution of the clinical features. The patient was discharged after 1 week of anticoagulant therapy with a stable Doppler ultrasound pattern. Early diagnosis and prompt initiation of anticoagulant therapy associated with careful surgical technique may reduce the risk of this life-threatening complication.

This article has been retracted at the request of the Editor-in-Chief. Reason: The Editor-in-Chief and Editorial Team of the EJSO very much regret that it has become necessary to retract this article formally. The journal was recently alerted to the fact that it duplicates substantial sections from an article previously published in Seminars of Surgical Oncology (Box JC, Edge SB. Laparoscopic cholecystectomy and unsuspected gallbladder cancer. Sem Surg Oncol 1999: 16; 327e31). The authors have been contacted but we have not received a satisfactory explanation for the remarkable similarities between the two papers. Their institution will be informed. Modern plagiarism detection software systems now allow very detailed comparative analysis of submitted texts

"Trasparenza" è termine polisenso la cui accezione, in ambito contrattuale e con particolare riguardo alla “trasparenza bancaria”, si può decrittare attribuendo alla locuzione un significato orientato ai fini della disciplina che la evoca. In questa prospettiva, “Trasparenza bancaria” significa conoscibilità degli elementi inerenti al rapporto negoziale nelle fasi precontrattuali, della conclusione e dell’esecuzione del contratto, che consente al cliente di conoscere e valutare l’operazione economica al momento della sua conclusione e, una volta concluso il contratto, di conoscere e valutare quell’operazione e controllare il comportamento della controparte. Risultati, questi, che si conseguono mediante l’adattamento di istituti tradizionali, ciò che inclina ad escludere che la nozione si configuri come un autonomo istituto giuridico. D’altro canto, la trasparenza non sembra configurabile neppure come un risultato fine a se stesso, bensì l’oggetto d’una istanza che, se soddisfatta, può mediatamente assistere il conseguimento di finalità ulteriori; e che non risulta circoscritta all’area dei soli rapporti negoziali in cui una delle parti sia rivestita dallo status di consumatore. A ciò si associa, in ambito contrattuale, la diffusione dell’uso del termine “trasparenza” nell’accezione dianzi precisata e delle relative regole, che pone l’ulteriore interrogativo se la trasparenza dia contenuto ad un principio generale.