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Richard D. Schulick, MD

Arch Surg. 2007;142(1):49.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

This report posits that postoperative ERCP is more cost-effective for incidental choledocholithiasis management after LC/IOC than LCBDE. They appear to prove this by performing a theoretical cost-effectiveness analysis. The authors make several very broad assumptions that do not necessarily reflect common scenarios in which we practice. For example, they calculate an opportunity cost of $4074 for taking the extra operating room time to perform the LCBDE. However, they do not acknowledge an opportunity cost for use of an ERCP suite, which would tend to counterbalance. They assume that the success rate of a "rescue" ERCP was 100% should either the initial ERCP or LCBDE fail. This is inaccurate, and the success rate diminishes after each successive failed attempt. Additionally, there is often a delay between the performance of a laparoscopic cholecystectomy with cholangiogram and subsequent ERCP in the order of days at most institutions, whereas an . . . [Full Text of this Article]

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