Objective: To compare the clinical efficacy of laparoscopic cholecystectomy (LC) plus laparoscopic common bile duct exploration (LCBDE) versus endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic sphincterotomy (EST) plus LC for cholecystolithiasis with choledocholithiasis in elderly patients. Methods: The clinical data of 94 elderly patients (over 60 years of age) with gallbladder and common bile duct stones undergoing minimally invasive therapy in China-Japan Union Hospital from October 2012 to April 2016 were retrospectively analyzed. Of the patients, 45 cases received LC plus LCBDE (LC+LCBDE group) and 49 cases had ERCP/EST plus LC (ERCP/EST+LC group), and the main clinical variables between the two groups of patients were compared. Results: In LC+LCBDE group versus ERCP/EST+LC group, the surgical success rate (93.3% vs. 89.8%, P=0.539) and incidence of postoperative complications (8.9% vs. 10.2%, P=0.892) showed no significant difference, but the hospitalization cost was significantly decreased (37 735 yuan vs. 48 260 yuan, P<0.001) and length of hospital stay was significantly shortened (11.51 d vs. 13.39 d, P=0.015). A total of 81 patients from both groups were followed up for 6 to 48 months; the incidence of stone recurrence and biliary tract infections showed no significant difference between the two groups of patients,and no cases of biliary stricture, pancreatitis or malignant transformation of the bile ducts occurred in either group of patients. Conclusion: LC+LCBDE approach has obvious advantages in reducing the cost and length of hospitalization, is not limited by the number and size of the choledocholithiasis, and further, it can preserve the function of the sphincter of Oddi. So, it should be considered as the first choice of option in most elderly patients. However, based on the individualization principle,this procedure should be selected flexibly according to the patients’ and technical conditions.