Objective: To assess the efficacy and safety of repeat biliary surgery for recurrent choledocholithiasis through laparoscopic procedure. Methods: One hundred and forty patients who had history of biliary surgery for bile duct stones and required repeat operation for recurrent choledocholithiasis were equally randomized into two groups, to receive laparoscopic (laparoscopic group) or open operation (laparotomy group), respectively. The main surgical variables between the two groups were compared. Results: In laparoscopic group compared with laparotomy group, the operative time (117.5 min vs. 125.3 min), intraoperative blood loss (67.3 mL vs. 113.2 mL), time to bowel function recovery (25.3 h vs. 55.2 h) and length of postoperative hospital stay (6.9 d vs. 12.4 d) were all significantly decreased (all P<0.05), while the hospitalization expense was increased (10 100 yuan vs. 9 600 yuan), but it did not reach a statistical significance (P>0.05). The number of patients using analgesics, and the incidence of wound infection in laparoscopic group were lower than those in laparotomy group (7 vs. 17; 2.9% vs. 12.9%, both P<0.05), while the incidence of bile leakage, biliary stricture, residual stone, and stone recurrence showed no statistical difference between the two groups (all P>0.05). Conclusion: Under the guidance of experienced surgeons, adequate preoperative preparation and assessment along with precise and meticulous operation, the repeat biliary surgery for recurrent choledocholithiasis by laparoscopic procedure is safe and effective, and also possesses the advantages of less bleeding, low incidence of postoperative infection and fast recovery.