Title: Feasibility of Cholecystectomy in Patients with Silent Common Bile Duct Stones Cohort
prospective single arm multicentre study
Version: 3 Date: 16 Jul 2024
Reviewer:  Roberto Campagnacci
Reviewer's report:
This paper is focused on a longtime previous  debated similar issue: CBD stones undetected and
or unexpected preoperatively. In that case, about 10% of cases, what we were doing to do? Single
step lap choley/CBD stones removal? Postoperative ERCP? In some papers, authors reported the
single step propcedure even when cbd stones were known before lap  choley, otherwise postop
ERCP remained in a large part of case the main choice. (  (E.A.E.S. multicenter prospective
randomized trial comparing two-stage vs single-stage management of patients with gallstone
disease and ductal calculi
A Cuschieri 1, E Lezoche, M Morino, E Croce, A Lacy, J Toouli, A Faggioni, V M Ribeiro, J
Jakimowicz, J Visa, G B Hanna)
HPB (Oxford) 2017 Jan;19(1):29-35.
doi: 10.1016/j.hpb.2016.10.011. Epub 2016 Nov 24.
A 23 year experience with laparoscopic common bile duct exploration
Silvia Quaresima 1, Andrea Balla 2, Mario Guerrieri 3, Roberto Campagnacci 3, Emanuele
Lezoche 2, Alessandro M Paganini     )
Anyway, the natural history of small CBD stones remains an unresolved question; in fact not all
patients experienced an uncomplicated spontaneous passage through Vater’s papilla (low grade
pancratits, pain, discomfort). On the other hand, ERCP remain a not free complication procedure.
So, in this way, I think finally that any effort toward the best practice in term of cost/benefit
evaluation should be well accepted. Undoubtdely it will be necessary to have incontrovertible
randomized studies to confirm as an reliable choice the wait and see strategy. Last but not least,
I would remind the authors as in some countries, as Italy for instance, how medical practice can
be subject to criminal low, and, as a consequence, how the surgical community may be reluctant
to accept a procedure that is not perfectely shared worldwide.
So, I exhort the authors to report and underline this concept in the final part of theis conclusions,
as well as to hope ta have a concistent series of well structured clinical studies to confirm and
support any individual experience.
The paper of Ahmad Maklad and colleagues in my opinion, taking my considerations into
account, is suitable for publication precisely because it allows us to glimpse an alternative not
invasive clinical path.
Sicerely
Roberto Campagnacci, MD,PhD
Title: Feasibility of Cholecystectomy in Patients with Silent Common Bile Duct Stones Cohort
prospective single arm multicentre study
Version: 3 Date: 16 Jul 2024
Reviewer:  Roberto Campagnacci
Reviewer's report:
This paper is focused on a longtime previous  debated similar issue: CBD stones undetected and
or unexpected preoperatively. In that case, about 10% of cases, what we were doing to do? Single
step lap choley/CBD stones removal? Postoperative ERCP? In some papers, authors reported the
single step propcedure even when cbd stones were known before lap  choley, otherwise postop
ERCP remained in a large part of case the main choice. (  (E.A.E.S. multicenter prospective
randomized trial comparing two-stage vs single-stage management of patients with gallstone
disease and ductal calculi
A Cuschieri 1, E Lezoche, M Morino, E Croce, A Lacy, J Toouli, A Faggioni, V M Ribeiro, J
Jakimowicz, J Visa, G B Hanna)
HPB (Oxford) 2017 Jan;19(1):29-35.
doi: 10.1016/j.hpb.2016.10.011. Epub 2016 Nov 24.
A 23 year experience with laparoscopic common bile duct exploration
Silvia Quaresima 1, Andrea Balla 2, Mario Guerrieri 3, Roberto Campagnacci 3, Emanuele
Lezoche 2, Alessandro M Paganini     )
Anyway, the natural history of small CBD stones remains an unresolved question; in fact not all
patients experienced an uncomplicated spontaneous passage through Vater’s papilla (low grade
pancratits, pain, discomfort). On the other hand, ERCP remain a not free complication procedure.
So, in this way, I think finally that any effort toward the best practice in term of cost/benefit
evaluation should be well accepted. Undoubtdely it will be necessary to have incontrovertible
randomized studies to confirm as an reliable choice the wait and see strategy. Last but not least,
I would remind the authors as in some countries, as Italy for instance, how medical practice can
be subject to criminal low, and, as a consequence, how the surgical community may be reluctant
to accept a procedure that is not perfectely shared worldwide.
So, I exhort the authors to report and underline this concept in the final part of theis conclusions,
as well as to hope ta have a concistent series of well structured clinical studies to confirm and
support any individual experience.
The paper of Ahmad Maklad and colleagues in my opinion, taking my considerations into
account, is suitable for publication precisely because it allows us to glimpse an alternative not
invasive clinical path.
Sicerely
Roberto Campagnacci, MD,PhD
Please review this paper.
user
Title: Feasibility of Cholecystectomy in Patients with Silent Common Bile Duct Stones Cohort
prospective single arm multicentre study
Version: 3 Date: 16 Jul 2024
Reviewer:  Roberto Campagnacci
Reviewer's report:
This paper is focused on a longtime previous  debated similar issue: CBD stones undetected and
or unexpected preoperatively. In that case, about 10% of cases, what we were doing to do? Single
step lap choley/CBD stones removal? Postoperative ERCP? In some papers, authors reported the
single step propcedure even when cbd stones were known before lap  choley, otherwise postop
ERCP remained in a large part of case the main choice. (  (E.A.E.S. multicenter prospective
randomized trial comparing two-stage vs single-stage management of patients with gallstone
disease and ductal calculi
A Cuschieri 1, E Lezoche, M Morino, E Croce, A Lacy, J Toouli, A Faggioni, V M Ribeiro, J
Jakimowicz, J Visa, G B Hanna)
HPB (Oxford) 2017 Jan;19(1):29-35.
doi: 10.1016/j.hpb.2016.10.011. Epub 2016 Nov 24.
A 23 year experience with laparoscopic common bile duct exploration
Silvia Quaresima 1, Andrea Balla 2, Mario Guerrieri 3, Roberto Campagnacci 3, Emanuele
Lezoche 2, Alessandro M Paganini     )
Anyway, the natural history of small CBD stones remains an unresolved question; in fact not all
patients experienced an uncomplicated spontaneous passage through Vater’s papilla (low grade
pancratits, pain, discomfort). On the other hand, ERCP remain a not free complication procedure.
So, in this way, I think finally that any effort toward the best practice in term of cost/benefit
evaluation should be well accepted. Undoubtdely it will be necessary to have incontrovertible
randomized studies to confirm as an reliable choice the wait and see strategy. Last but not least,
I would remind the authors as in some countries, as Italy for instance, how medical practice can
be subject to criminal low, and, as a consequence, how the surgical community may be reluctant
to accept a procedure that is not perfectely shared worldwide.
So, I exhort the authors to report and underline this concept in the final part of theis conclusions,
as well as to hope ta have a concistent series of well structured clinical studies to confirm and
support any individual experience.
The paper of Ahmad Maklad and colleagues in my opinion, taking my considerations into
account, is suitable for publication precisely because it allows us to glimpse an alternative not
invasive clinical path.
Sicerely
Roberto Campagnacci, MD,PhD
assistant