Objective: To compare the clinical efficacy of primary closure versus T-tube drainage after laparoscopic common bile duct exploration (LCBDE) for common bile duct stones. Methods: The clinical data of 142 patients with common bile duct stones undergoing LCBDE from January 2012 to December 2014 were retrospectively analyzed. Of the patients, 75 cases received primary closure of the common bile duct and 67 patients were subjected to T-tube drainage after choledochotomy. The relevant clinical variables between the two procedures were compared, and the risk factors for postoperative complications were also analyzed. Results: Between patients undergoing the two different procedures, all preoperative variables, except the gender ratio that was of a statistical difference (P=0.028), exhibited no significant difference (all P>0.05); the operative time, and incidence of postoperative complications, surgical death and stone recurrence also showed no significant difference (all P>0.05), but the length of postoperative hospital stay in patients undergoing primary closure was significantly shorter than that in patients undergoing T-tube drainage (P<0.05). Biliary fistula was the main postoperative complication for either procedure, which occurred in 7 cases (9.3%) in patients undergoing primary closure and in 8 cases (11.9%) in those undergoing T-tube drainage, respectively. No risk factors for postoperative biliary fistula was detected by comparison of the relevant variables between patients with and without postoperative biliary fistula (all P>0.05). Conclusion: LCBDE with primary closure of the common bile duct is an effective and safe procedure for common bile duct stones, and it has similar clinical efficacy but reduced length of postoperative hospital stay compared with post-LCBDE T-tube drainage. The determination of risk factors for biliary fistula still requires big data analyses and further randomized controlled trials.