2 Recent cases referred to a hepatobiliary surgeon at our tertiary center highlighted the complexity of managing CBDS. The first was a patient with a past history of open subtotal cholecystectomy 20 years prior and open repair of colovesical fistula. This patient was found to have cholelithiasis in the gallbladder remnant and 2 stones impacted at the cystic duct/CBD junction. The surgeon performed a laparoscopic division of adhesions, completion cholecystectomy, and transcystic clearance of the CBDS via choledochoscopy and basket extraction.