Laparoendoscopic Rendezvous for Concomitant Gall Bladder Stones and Common Bile Duct Stones

Inclusion Criteria: * Patients having stone(s) in the gallbladder and concurrent common bile duct , as determined by MRCP(magnetic resonance cholangiopancreatography) or US. * Patients with acute cholecystitis, acute cholangitis, obstructive jaundice, and those with highly suspicious criteria for common bile duct stones, such as dilated CBD( common bile duct ) on US examination \> 7 mm in diameter without obvious common bile duct stones, high serum bilirubin level, and/or high serum alkaline phosphatase level, were also included in this study. (high risk for cholecystocholedocholithiasis) * Previous failed ERCP attempt * Patients fit for general anesthesia and tolerant of pneumoperitoneum and endoscopic procedures. Exclusion Criteria: * History of hepatobiliary surgery as choledochoduodenal anastomosis * A Previous upper abdominal surgery as total or partial gastric resection. * Morbid obesity. * Uncorrectable coagulopathy. * Patients who refused to give consent. * Pregnancy. * Suspected malignant biliary stricture or cholangiocarcinoma * Severe acute cholangitis with hemodynamic instability or septic shock requiring immediate biliary drainage (may necessitate emergent ERCP or percutaneous drainage first) * Impacted CBD stones or stones deemed too large for endoscopic extraction (e.g., \> 1.5 cm) * Severe cardiopulmonary disease significantly increasing operative risk. * Intrahepatic bile duct stones with indications for surgery. * Patients with choledocholithiasis \>2 cm or a large number of stones were difficult to remove.