Experienced hepatobiliary surgeons are profi cient at performing bilioenteric anasto­moses for a variety of indications, including pancreaticoduodenectomy , repair of bile duct injuries, or transplantation. Biloenteric bypass ( hepaticojejunostomy , cho­lechochojejunostomy or choledochoduodenostomy ) was the standard treatment for patients with primary common bile duct stones or for patients who failed endo­scopic stone removal. Advances in laparoscopic and endoscopic techniques have made open operation infrequently necessary. It was diffi cult to fi nd a recent refer­ence of open cholechoenterostomy for common bile duct stones. The title, Open Choledocho - Enterostomy for Common Bile Duct Stones : Is it Out of Date in Laparo ­ Endosocopic Therapy , indicates the infrequency that open surgical biliary bypass is performed for retained or recurrent bile duct stones in the absence of bile duct stric­ture [ 18 ]. Abdelmajid et al., performed 51 biliary enteric bypasses with excellent results between 2005 and 2009 for elderly patients, most of whom had multiple stones (at least fi ve), or unextractable calculi (Table 20.3 ). Li studied the results of 193 patients treated by open cholecholithotomy and T-tube drainage – 81, cholecho­duodenostomy – 41, or choledochojejunsotomy – 71 [ 19 ]. This series include patients with primary common bile duct stones – 81, and those with secondary bile stones that presumably originated in the gallbladder – 112. The authors found a signifi cantly lower rate of recurrent symptoms in patients treated by choledocho­duodenostomy than those with either T-tube drainage or choledochojejuonostomy. This difference was more pronounced in those patients with primary common bile duct stones (cholechochoduodenostomy – 2.6 %; choledochojejunostomy – 14.7 %; T-tube drainage – 36.4 %). Small series have been reported using laparoscopic cho­ledochoduodenostomy for biliary obstruction [ 20 , 21 ]. The paper by Chander had 27 patients with dilated common bile ducts (>15 mm) with multiple stones, recur­rent stones or primary common bile duct stones. Details of patient follow up are limited, but they report no deaths, with minimal morbidity and no recurrence of symptoms [ 21 ]. For historical purposes, we have included a paper from Johns Hopkins during the open cholecystectomy era, in our analysis [ 22 ]. The authors treated 30 patients with primary common bile duct stones, defi ned as patients with a 2 year symptom free interval following cholecystectomy in the absence of a long cystic duct remnant or biliary stricture . Most patients presented with acute cholan­gitis , and the mean interval to developing symptoms was 12 years. Twenty six of the 30 patients had simple stone extraction and T-Tube placement, with no recurrent stones in 82 %. Four patients had biliary drainage by choledochoduodenostomy (3) or sphincteroplasty (1) without recurrent symptoms or stones.