Objective To investigate the effect of laparoscopic common bile duct exploration(LCBDE) in the elderly patients with choledocholithiasis using the concept of enhanced recovery after surgery (ERAS). Methods A total of 120 elderly patients were included in the study, who were treated for choledocholithiasis in the Department of General Surgery of the Third Affiliated Hospital of Inner Mongolia Medical University from February 2014 to March 2018. They were randomly divided into ERAS group and control group with 60 in each, with the former being treated with ERAS regimen and the latter with routine procedure. The two groups were compared in the postoperative efficacy, complications and analgesia. SPSS statistics 18.0 was used to process the data. Student′s t test, Chi-square test or rank sum test was performed. Results Compared with the control group, the patients in the ERAS group got out of bed earlier [(9.62±2.35) vs (22.51±3.32) h], passed gas earlier [(22.13±5.12) vs (37.51±6.43) h], started eating earlier [(18.75±3.28) vs (34.69±4.47) h], had shorter hospital stay [(9.73±1.48) vs (14.73±2.92) d] and less hospitalization cost [(1.68±0.23)×10⁴ vs (2.47±0.32)×10⁴ RMB￥], and had lower rates of pulmonary infection [5.00%(3/60) vs 13.33%(8/60)], of urinary tract infection [3.33%(2/60) vs 11.67%(7/60)] and of abdominal distention [8.33%(5/60) vs 20.00%(12/60)]. The differences were all statistically significant (P<0.05). The proportion of the patients with satisfactory postoperative analgesia in the ERAS group was 81.67%(49/60), which was significantly higher than that in the control group [48.33%(29/60), P<0.05]. Conclusion LCBDE in elderly patients with ERAS is safe and effective, and is worth popularizing.