Objective: To investigate the efficacy of laparoscopic common bile duct exploration (LCBDE) under the concept of fast-track surgery (FTS) in elderly patients. Methods: The clinical data of 35 elderly patients undergoing LCBDE under FTS perioperative management from September 2013 to September 2016 (FTS group) and 31 patients undergoing LCBDE with traditional perioperative management during September 2011 to August 2013 (traditional group) were retrospectively analyzed. The relevant clinical variables between the two groups of patients were compared. Results: In FTS group compared with traditional group, the time to postoperative ambulation (15.34 h vs. 26.94 h), and time to first anal gas passage (23.09 h vs. 36.65 h), defecation (53.83 h vs. 62.03 h) and food intake (22.91 h vs. 53.29 h) as well as the length of hospital stay (6.29 d vs. 9.42 d) and hospitalization costs (17 200 yuan vs. 25 400 yuan) were all significantly reduced (all P<0.05). In addition, the postoperative nutritional indexes, overall incidence of complications and analgesic effects in the FTS group were all superior to those in traditional group (all P<0.05). Conclusion: LCBDE under the FTS protocol is safe and effective for elderly patients. However, the principle of individuation should also be followed for improving the patients’ compliance, and the multi-disciplinary cooperation should be enhanced.