Objective To compare the clinical effect of laparoscopic cholecystectomy (LC)combined with transcystic duct common bile duct exploration (TCD-CBDE) and ch oledochotomy common bile duct exploration (C-CBDE) in the treatment of cholecystolithiasis with choledocholithiasis. Methods The clinical data of 209 patients with cholecystolithiasis combind with choledocholithiasis underwent surgical treatment were reviewed retrospectively and followed up. The mean operative time, rate of conversion to open surgery, length of postoperative hospital stay, complete ductal clearance rate, incidence of after surgery, biliary leakage rate and recurrent stone rate were compared between two groups utilizing t test, chisquare test or Fisher exact test. Results Of 209 patients, 131(6268%) patients were managed by LC+TCD=CBDE and 78(37.32%) patients underwent LC+C-CBDE. The mean operative time, the rate of conversion to open surgery, length of postoperative hospital stay, the incidence of complication after surgery and the biliary leakage rate in LC+C-CBDE group were significantly more than those in LC+TCD-CBDE group (all P＜0.05). There was no significant difference in the complete ductal clearance rate and the recurrent stone rate between two groups (P＞0.05). Conclusion LC combined different approach of LCBDE is safe and effective when taking the indication and contraindication for TCD-CBDE and C-CBDE strictly.