Objective To compare the clinical effects of primary common bile duct closure and T-tube drainage after laparoscopic common bile duct exploration (LCBDE) for elderly patients with choledocholithiasis. Methods The clinical data of 158 elderly patients with choledocholithiasis performed LCBDE from Jan. 2017 to Dec. 2018 were collected and analyzed retrospectively. According to the operation procedure after LCBDE, patients were divided into primary common bile duct closure group (n=130) and T-tube drainage group (n=28). The preoperative baseline data, operation time, blood loss, postoperative hospitalization time, total hospitalization costs, postoperative complications incidence and stone recurrence rate were compared between the two groups. Results There was no difference between two groups in terms of gender, age, hypertension, diabetes, choledochal diameter, preoperative total bilirubin, alanine aminotransferase (P>0.05). The primary common bile duct closure group was superior to T-tube drainage group on operation time and postoperative hospitalization time (P<0.05). And there was no difference between the two groups on blood loss, total hospitalization costs, postoperative complications incidence and recurrence rate of stones (P>0.05). Conclusion Elderly (age≥60 years) is not an absolute contraindication for primary common bile duct closure after LCBDE. With correctly understanding the indications and contraindications, primary common bile duct closure after LCBDE is also safe and feasible for elderly patients with choledocholithiasis.