We read with great interest the study of Ballou and colleagues regarding their 10 year single tertiary institution experience of laparoscopic common bile duct exploration in the March 2019 edition of The American Journal of Surgery.1 We would like to express our appreciation of this report portraying retrospective data on single stage versus two-staged management of choledocholithiasis. Firstly, we would be very interested to know why the authors experienced such a high failure rate of laparoscopic common bile duct exploration (LCBDE) in their series (33%).

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