Author Affiliations: Department of General Surgery, Pennine Acute Hospitals Trust, The Royal Oldham Hospital, Oldham, England.
As Dr Maa has observed, the April 2011 “Image of the Month” article raises a number of issues regarding the management of gallstone problems. In the gall bladder, stones are a nuisance. In the bile duct, they are potentially lethal. Prior to the 1980s, surgeons essentially held sole responsibility for the treatment of common bile duct stones. In patients presenting with clear evidence of common bile duct stones who appear unfit for cholecystectomy, endoscopic retrograde cholangiopancreatography is often performed to drain and/or clear the bile duct. In a significant proportion of cases, this can eliminate the need for cholecystectomy, but complete surgical clearance of gallstones should be our aim wherever possible.1
Flook D, Alkhaffaf B, Parkin E. Emerging Trends in Endoscopic Retrograde Cholangiopancreatography and Common Bile Duct Exploration—Reply. Arch Surg. 2011;146(11):1336-1337. doi:10.1001/archsurg.2011.305