Randomized clinical trial of open versus laparoscopic cholecystectomy in the treatment of acute cholecystitis (Br J Surg 2005; 92: 44–49)

Sir Of 35 patients in this study randomized to undergo laparoscopic cholecystectomy, eight were converted to an open procedure. In the statistical analysis this fact was not taken into consideration. The authors also mention that patients with a serum bilirubin level above 3·5 mg/dl were not included in the study, presumably to exclude patients with stones in their bile duct. Yet they carried out intra-operative cholangiography in all the patients, with a stone detection rate of only five out of 70 (7·1 per cent) patients. The availability of a non-invasive test like magnetic resonance cholangiography to detect bile duct stones means that the use of routine intra-operative cholangiography is difficult to justify.