Objective To investigate the efficacy and safety of laparoscopic common bile duct exploration （LCBDE） and primary suture in the treatment of choledocholithiasis. Methods A total of 220 patients with choledocholithiasis treated with LCBDE from June 2022 to May 2024 were selected as study subjects, and randomly divided into a primary suture group （124 cases） and a T-tube drainage group （96 cases）. The efficacy of the two groups was compared. Results The operation time, postoperative drainage time, hospital stay, postoperative ambulation time, and gastrointestinal function recovery time of the primary suture group were significantly shorter than those of the T-tube drainage group （P<0.05）. The amount of blood loss during operation was not different between the two groups （P>0.05）. Before operation, the bilirubin indexes were not different between the two groups （P>0.05）; at postoperative 3 d, the bilirubin indexs of the two groups were significantly reduced compared with before operation, and the indexes in the primary suture group were lower than those in the T-tube drainage group （P<0.05）. The complication rate of the primary suture group was significantly lower than that of the T-tube drainage group （P<0.05）. After 6 months of follow-up, no recurrence of stones was found by choledochoscopy. Conclusion Compared with T-tube drainage, the application of primary suture in LCBDE has better clinical effect and higher safety, which is conducive to the rehabilitation of patients.