Author Affiliations: Cambridge Hepatobiliary Service (Drs Dawwas, Jah, Griffiths, Huguet, and Gimson), and Department of Radiology (Dr Winterbottom), Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
We thank Dr Maa for his comments regarding our report. Although bile duct exploration is undeniably a well-established treatment modality for choledocholithiasis (not least when endoscopic therapy has failed), we did not feel that it would be an appropriate management option in our case for a number of reasons.
First, our patient was an 89-year-old man with significant comorbidities, including ischemic heart disease, diabetes mellitus, and a 9-cm abdominal aortic aneurysm, for whom the risks of biliary surgery were considerable and further accentuated by the possibility of postoperative aneurysm rupture.1
Dawwas MF, Jah A, Griffiths WJH, Winterbottom AP, Huguet EL, Gimson AE. Emerging Trends in Endoscopic Retrograde Cholangiopancreatography and Common Bile Duct Exploration—Reply. Arch Surg. 2011;146(11):1336-1337. doi:10.1001/archsurg.2011.304