Disease description: Extrahepatic bile duct stones refer to bile duct stones present below the bifurcation of the right and left hepatic ducts, including common hepatic duct and common bile duct stones. Primary extrahepatic bile duct stones account for the majority of stones, mostly bile pigment or mixed stones; secondary stones refer to stones in the gallbladder or intrahepatic bile duct stones draining into the extrahepatic bile duct, mostly cholesterol stones. Clinical manifestations: typical abdominal pain, chills, high fever and jaundice may appear when stones cause bile duct obstruction, often accompanied by gastrointestinal symptoms such as nausea and vomiting; in severe cases, manifestations of acute septic obstructive cholangitis such as altered mental status or shock, and untimely treatment will lead to death due to severe infectious shock. ERCP is an invasive diagnostic and therapeutic tool that can be used to remove stones by endoscopic oddis sphincterotomy and drainage by nasal bile duct or stent. Treatment: The principle of treatment for extrahepatic bile duct stones is to remove as many stones as possible during surgery, to remove the foci of infection, and to open the bile duct for drainage. Choledochotomy is the classic procedure for the treatment of extrahepatic bile duct stones. Combining choledochoscopic exploration can improve the efficiency of stone removal and also reduce biliary tract injury and improve surgical safety. Currently, laparoscopic choledochotomy and choledochoscopic stone extraction is advocated. For patients with recurrent extrahepatic bile duct stones, if the oddis sphincter is dysfunctional, choledochotomy Roux-Y can be performed to preserve the function of the oddis sphincter as much as possible and reduce the occurrence of reflux cholangitis. Our department features Our department features: often using a combination of laparoscopic and ERCP, choledochoscopic techniques, our department cures more than 80% of patients with extrahepatic bile duct stones in a minimally invasive way, with stone recurrence rate, residual stone rate, and surgical complications significantly lower than traditional open surgery. A 62-year-old male patient with “yellow sclera with fever for 2 weeks” was admitted to our department, and MRCP showed one stone of 25px and 20px in diameter in the lower and middle bile ducts, dilated upper bile duct and gallbladder stone. This patient had undergone major gastrectomy-BiII reconstruction 10 years ago, which made ERCP treatment more difficult and risky. After full communication with the patient, “laparoscopic complex intestinal adhesion release + cholecystectomy + choledochotomy and choledochoscopy for stone extraction” was performed, which took 3 hours. The patient was discharged 3 days after the operation, with good quality of life at six months follow-up.