Introduction: ERCP has emerged as overwhelmingly dominant option for management of CD. LCBDE is relegated as distant second & OCBDE is considered only when ERCP or LCBDE are unavailable. A recent study (JAMA Surgery 2016;151:1125-30) has expressed concerns that CBDE may be at risk of disappearing from surgical armamentarium. We report our experience with OCBDE in complex CD where ERCP failed and LCBDE was not feasible. Methods: 10 year observational study of 27 consecutive patients (15 males, 12 females; median age 55 years) of OCBDE (1.7% of 1600 ERCPs for CD) with holmium laser lithotripsy was performed. Peroperative choledochoscopy was preferred method to confirm stone clearance. In group A (n = 18) choledochotomy was primarily closed over endoscopic biliary stent. Group B (n = 9) patients underwent choledochojejunostomy for benign strictures / multiple stones / previous cholecystojejunostomy / Mirizzi's syndrome type III. Outcome measures included postoperative morbidity and 30 day mortality. Results: OCBDE indications included failed ERCP &/or large (2 cm) / multiple / impacted stones (n = 17), Mirizzi's syndrome type II & III (n = 4) or benign biliary strictures with stones (n = 6). Most common complication was wound infection 3 (11 %). Median length of stay was 6 (range 4e10) days. In group A, two patients (11%) each had transient bile leak and retained stones which were endoscopically removed. One (3.7 %) patient died due to massive bleeding. Conclusion: In the current era, indications for OCBDE are limited. However OCBDE is the only treatment for complex CD and shall remain integral part of surgical armamentarium.

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