This is a procedure favored by many, especially in place of the transduodenal approach for stones impacted in the ampulla. As overlooked common duct stones are identified or reformed, the efficacy of their removal by endoscopists and interventional radiologists has improved. Large common ducts may be associated with symptoms, especially in the elderly. A dilated common duct with recurrent bouts of cholangitis associated with diverticuli with or without stones is an indication for this procedure. Strictures of the lower common duct following previous biliary surgery can become symptom-free after choledochoduodenostomy. However, the procedure should not be considered for a nondilated common duct, malignancy of the lower end of the common duct, recurrent pancreatitis, sclerosing cholangitis, or inflammation involving the proximal duodenum. The procedure of choledochoduodenostomy in properly selected patients may be far safer, with long-term results more satisfactory, than those that follow more complicated procedures for the excision of diverticuli. The common duct should be at least 2.4 cm in diameter.