Objective To investigate the application effect of enhanced recovery after surgery (ERAS) for laparoscopic cholecystectomy (LC) combined with laparoscopic common bile duct exploration (LCBDE) in elderly patients. Methods Clinical data of 145 elderly patients (over 65 years) who underwent LC combined with LCBDE between Apr. 2015 and Apr. 2019 in Renhe Hospital was retrospectively analyzed. Among them, 55 patients received ERAS perioperative management (ERAS group), and 90 patients received traditional perioperative management (traditional group). Differences in stress response parameters, liver and kidney function before and after surgery, postoperative complications incidence, postoperative recovery and satisfaction between the two groups were compared. Results The stress response parameters, including white blood cell (WBC) count [(10.83±2.06)×10⁹/L vs (11.94±1.68)×10⁹/L, t=3.53, P<0.01], C-reactive protein (CRP) level [(25.22±8.38)mg/L vs (28.42±9.29)mg/L, t=2.09, P=0.04] and blood glucose level [(4.91±1.02)mmol/L vs (6.01±1.10)mmol/L, t=5.99, P<0.01], were significantly lower in ERAS group than those in traditional group 1 d after surgery (P<0.05). There were no statistical significant difference in liver and kidney function index between the two groups (P>0.05). The overall complication rate of ERAS group was lower than that of traditional group (15/55 vs 71/90, χ²=37.69, P<0.01), the incicences of inausea and vomiting (3/55 vs 18/90, χ²=5.83, P=0.02), pain in trocar incision sites (2/55 vs 18/90, χ²=7.69, P<0.01) were significantly lower in ERAS group than that in traditional group. Postoperative recovery, including time of flatus [(1.23±0.42)d vs (1.58±0.50)d, t=4.45, P<0.01], length of hospitalization time [(7.16±1.07)d vs (8.96±2.36)d, t=5.36, P<0.01], hospitalization expense [(1.75±0.31) ten thousand Yuan vs (1.96±0.26) ten thousand Yuan, t=4.29, P<0.01] and satisfaction [(94.34±13.42)points vs (82.78±10.71)points, t=5.73, P<0.01] were significantly better in ERAS group than those in traditional group (P<0.01). Conclusion ERAS is a safe and effective procedure that can be used in perioperative management of LC combined with LCBDE for elderly patients, which can reduce stress response and postoperative complications incidence, accelerate postoperative recovery, and shorten hospitalization time, improve patient satisfaction.