Objective: To investigate the safety and effectiveness of laparoscopic common bile duct exploration (LCBDE) with primary closure in treatment of choledocholithiasis in elderly patients. Methods: The clinical and follow-up data of 146 patients with gallbladder stones and concomitant choledocholithiasis undergoing LCBDE with primary closure from December 2012 to December 2016 were retrospectively analyzed. The patients were divided into two groups according to their age, with 61 cases ≥65 years old in elderly group and 85 cases <65 years old in non-elderly group. The main clinical variables between the two groups of patients were compared. Results: LCBDE with primary closure was uneventfully completed in all the 146 patients, without any open conversion. In elderly group versus non-elderly group, the operative time (90.98 min vs. 93.12 min), intraoperative blood loss (25.08 mL vs. 24.94 mL) and number of stones in the common bile duct (2.36 vs. 1.98) showed no statistical difference (all P>0.05), but the postoperative drainage time (4.74 d vs. 4.13 d), time to ambulation (1.87 d vs. 1.61 d), time for bowel function recovery (2.43 d vs. 2.05 d) and length of hospital stay (7.46 d vs. 6.62 d) were significantly prolonged (all P<0.05). No serious complications occurred in either of the groups, and no significant differences were noted in incidence of bile leakage (9.8% vs. 9.4%), abdominal bleeding (1.6% vs. 2.4%), residual stone rate (1.6% vs. 1.2%) and stone recurrence rates (1.6% vs. 0) between the two groups (all P>0.05). Conclusion: LCBDE with primary closure is safe and effective in treatment of choledocholithiasis in elderly patients, and can be used as a preferable surgical procedure for elderly patients with choledocholithiasis under adherence to strict surgical indications.