Management of choledocholithiasis in patients undergoing cholecystectomy.

摘要

I read with interest the study by O'Neill et al. on the management of choledocholithiasis in patients undergoing cholecystectomy between two hospitals.I have a few comments regarding the article. First, analysis of data from two different practices combined will clearly bias a particular practice. Second, it is not surprising that open cholecystectomy with bile duct exploration (OCBDE) was the most successful modality because it is still considered the gold standard. Third, the title stated that choledocholithiasis was overdi-agnosed endoscopically, but no data on time lag from endoscopic retrograde cholangiopancreatography (ERCP) to operative clearances were presented. Spontaneous stone migrations are not uncommon. They also did not take into account the occurrence of ERCP clearance without proceeding to laparoscopic cholecystectomy (LC). Patients declining LC after ERCP clearance are not uncommon. Not taking into account these factors will certainly bias one and favour another modality.