BACKGROUND: Laparoscopic common bile duct exploration and primary suture (LBEPS) offers advantages such as minimal invasion, shorter operative time, and faster postoperative recovery in the treatment of common bile duct stones.However, its safety in elderly patients remains controversial. METHODS: A retrospective analysis was conducted on the clinical data of 128 patients with common bile duct stones who underwent LBEPS treatment in our hospital from December 2018 to March 2025.The patients were divided into an elderly group (≥ 65years, n = 55) and a non-elderly group (< 65years, n = 73) based on age.Baseline characteristics, operative time, postoperative complications, recurrence rate, and other indicators were compared between the two groups. RESULTS: There were no significant differences in baseline characteristics, such as sex, body mass index(BMI), or stone diameter, between the two groups (P > 0.05). The diameter of the common bile duct was significantly larger in the elderly group compared to the non-elderly group (P < 0.05). There were no significant differences in alanine aminotransferase (ALT), aspartate aminotransferase(AST), total bilirubi (TB), direct bilirubin (DB), white blood cells (WBC), haemoglobin (HGB), or platelet (PLT) levels between the two groups before and after surgery(P > 0.05). However, the postoperative drainage time and total hospital stay were longer in the elderly group (P < 0.05). The presence of hepatitis B was identified as an independent risk factor for complications after LBEPS. CONCLUSION: The clinical application of LBEPS in elderly patients with common bile duct stones is safe and feasible.Elderly patients require a longer preoperative length of stay compared to non-elderly patients.Patients with common bile duct stones and concomitant hepatitis B are more prone to complications after LBEPS.