This case report addresses a clinically relevant and technically challenging problem in the management of choledocholithiasis when conventional ERCP is not feasible. The manuscript provides a detailed and reproducible description of the laparoscopic transcystic technique and intraoperative fluoroscopic guidance. The patient's clinical presentation, imaging findings, operative procedure, and postoperative course are generally well documented. The successful clearance of an 8-mm distal CBD stone demonstrates the technical feasibility of this approach in a carefully selected patient. The case's novelty is potentially valuable, although the specific contribution should be better supported by a comprehensive review of existing literature. The discussion appropriately considers alternative approaches, but several statements regarding safety, efficacy, cost-effectiveness, and superiority are stronger than can be supported by a single case. The reported one-month follow-up is reassuring but insufficient to establish long-term biliary safety or recurrence outcomes. Important details, including anticoagulation management, laboratory values, and the precise technique of papillary dilation, should be clarified. The manuscript would benefit from improved adherence to case-report reporting standards and more cautious, evidence-based language throughout the Discussion and Conclusion. Overall, the report has good clinical and technical value, but substantial revision is recommended to strengthen methodological rigor and ensure that conclusions remain proportionate to the evidence. CRITICAL REVIEW COMMENTS : Please moderate claims such as “safe,” “effective,” “least morbid,” and “most efficient,” as these cannot be established from a single case report; “technically feasible” would be more appropriate. Please provide the actual laboratory values (bilirubin, AST/ALT, ALP/GGT, WBC, CRP, amylase/lipase and coagulation profile) rather than stating that routine investigations were normal. The statement that the patient was “on anticoagulation” should be clarified, including the drug used, indication, perioperative interruption and resumption. Please clarify whether the duodenal stricture was definitively diagnosed as benign/peptic, since biopsies were deferred and the stated etiology appears presumptive. The terminology and technical details of ampullary balloon dilation/biliary sphincteroplasty should be described more precisely, including balloon position, diameter, pressure and duration. Please distinguish clearly between technical infeasibility of ERCP and an absolute contraindication to ERCP. The criteria stated for transcystic clearance (e.g., stones <10 mm and fewer than 10 stones) should be supported by appropriate references or presented as suggested selection criteria rather than definitive recommendations. Table 1 should provide more consistent information regarding study populations, definitions of stone-clearance success, complications and follow-up, because the included studies are heterogeneous. Please substantiate the claim that the specific use of an infant feeding tube is novel, preferably through a more comprehensive literature search. The one-month follow-up should be acknowledged as a limitation, particularly regarding recurrent stones, biliary stricture and delayed complications. Statements such as “essential reference for surgeons” should be removed or rephrased in neutral scientific language. Consider adding a CARE-style timeline to make the sequence of diagnostic evaluation, failed ERCP access, surgery, stone clearance and follow-up clearer. The conclusion should emphasize technical feasibility in a selected patient, rather than implying general safety or superiority over established alternatives.