Recurrent pyogenic cholangitis (RPC) is a condition characterized by recurrent bouts of cholangitis caused by bile stasis and stone formation proximal to biliary strictures. The pathogenesis is incompletely understood with stone formation occurring de novo within the intrahepatic bile ducts. On imaging, the extrahepatic and intrahepatic ducts are dilatated with focal areas of stricturing in the intrahepatic biliary tree. Repeated attacks can lead to progressive damage of the bile ducts and liver parenchyma, which can result in liver abscesses or cirrhosis.The management of these patients should involve a multidisciplinary approach given that endoscopic, surgical and radiologic interventions may be required. In that sense, a surgical biliary-enteric anastomosis is advocated to prevent long term complications and to minimize the number of interventions.In this video, we present the case of an elderly Asian patient with RPC and an extensive past surgical history who underwent a laparoscopic choledocoduodenostomy after numerous endoscopic biliary interventions. The case is presented in detail explaining the decision process and the surgical technique is described in a step-by-step fashion.