Gallstone disease affects 10–20% of the general population, with a prevalence that increases with age. In 8–18% of patients, gallstones are associated with common bile duct (CBD) stones. Endoscopic management is currently considered the standard approach for the treatment of CBD lithiasis. Nevertheless, endoscopic treatment is not without limitations and may be associated with complications. In addition, several clinical situations can make endoscopic stone extraction technically challenging or unfeasible. These difficulties are related to stone size and number, their anatomical location, and modifications of the biliary anatomy, most frequently following previous surgical procedures. In such contexts, choledochoduodenostomy (CDD) represents a potential surgical alternative.

The aim of this mini-review is to describe situations in which endoscopic management of CBD stones is difficult, to review the outcomes associated with choledochoduodenostomy, and to clarify its potential indications in contemporary practice. We performed an exhaustive review of the literature published over the past 15 years (2009–2024).

Overall, the available data suggest that choledochoduodenostomy can be a safe and effective option in carefully selected patients, particularly in elderly or multimorbid individuals, and in cases involving large stones or extensive choledocholithiasis. As a procedure that is technically accessible to trained surgeons and does not require advanced technical facilities, choledochoduodenostomy may deserve renewed consideration and broader inclusion in surgical training.