Background and Aims Laparoscopic common bile duct exploration (LCBDE) has become the main method and even the first-line recommended procedure for the treatment of common bile duct stones because of its clinical advantages of small trauma and rapid recovery. However, whether bile drainage is required after LCBDE and the choice of different bile drainage methods are still controversial, such as the discussion of the indications of traditional LCBDE plus external biliary drainage tube (T-tube), whether the primary suture alone leads to high incidence rate of postoperative complications, and whether the internal biliary drainage (double J-tube) is superior to T-tube. To solve the problem mentioned above, this study was conducted to compare the clinical application of T-tube drainage, double J-tube drainage and primary duct closure (PDC) in LCBDE through a retrospective method, and discuss their indications.Methods The clinical data of 363 patients undergoing LCBDE in the Second Affiliated Hospital of Kunming Medical University from March 2015 to May 2018 were retrospectively collected. The patients were divided into T-tube group (128 cases), double J-tube group (115 cases) and PDC group (120 cases) according to the treatment method used. The preoperative general data (sex, liver function, diameter of the common bile duct, and stone size), perioperative variables (operation time, postoperative hospital stays, and hospitalization cost), and incidence of postoperative complications (biliary pancreatitis, bile leakage, biliary stricture, tube detachment, and residual stones) were compared among the three groups.Results There were no significant differences in the preoperative general data among the three groups of patients (all P>0.05). The average operative time in PDC group (75.5 min) was shorter than that in T-tube group (98.5 min) or double J-tube group (90.5 min), the average length of hospital stay in PDC group (4.8 d) or double J-tube group (5.4 d) was shorter than that in T-tube group (7.8 d), and the average medical cost in PDC group (18 489 yuan) or double J-tube group (20 157 yuan) was less than that in T-tube group (24 034 yuan). All the differences had statistical significance (all P<0.05). There was no significant difference in the overall incidence of complications among the three groups (P=0.521), but the incidence rate of biliary leakage in PDC group (3.3%) was higher than those in the other two groups (both P<0.05), and all the patients had multiple bile duct stones (>1 stone), of whom, 3 cases had incarcerated calculus of the sphincter of Oddi, and the diameter of the common bile duct in 2 cases was less than 10 mm; the incidence rate of postoperative pancreatitis in double J-tube group (4.3%) was higher than those in the other two groups (both P<0.05), and the causes included duodenal papillary edema were caused by incarcerated stones in 2 cases, juxta-papillary duodenal diverticula in 2 cases, and inflammatory papillary stenosis in 1 case.Conclusion Although the PDC has some advantages in terms of length of hospital stay and cost of hospitalization, the incidence of postoperative complications is higher, and T-tube drainage and double J-tube drainage also have their own advantages and indications. The necessity of drainage and drainage method selection should be considered based on the patient's economic situation, combined with a comprehensive judgment on the biliary tract conditions by preoperative examination, intraoperative laparoscopy and choledochoscopy, so as to make an "individualized" determination, minimize the postoperative complications and improve patients' satisfaction.