ObjectiveTo evaluate the clinical utility of combining laparoscopic common bile duct exploration (LCBDE) with intraoperative endoscopic antegrade nasobiliary drainage (EANBD) for choledocholithiasis. MethodsPatients with choledocholithiasis who underwent LCBDE at Guanghan People’s Hospital from December 2023 to June 2025 were retrospectively enrolled and categorized into an EANBD group and a T-tube drainage group. Intraoperative and postoperative clinical indicators were compared between the two groups. MethodsBased on the inclusion and exclusion criteria, a total of 121 patients were enrolled, with 57 in the EANBD group and 64 in the T-tube drainage group. There were no significant differences in preoperative baseline data such as demographic characteristics, preoperative comorbidities, routine blood parameters, liver function, and morphological measurements of the bile duct and stones between the two groups (all P>0.05). Compared with the T-tube drainage group, the EANBD group showed significantly longer operative time, abdominal drainage duration, and postoperative hospital stay [110.0 (94.5, 127.5) min vs. 85.0 (75.0, 95.0) min; 7.0 (6.0, 8.0) d vs. 6.0 (6.0, 6.0) d; and 8.0 (7.0, 9.0) d vs. 7.0 (7.0, 7.0) d, all P<0.001]. However, the EANBD group had significantly shorter biliary drainage tube indwelling time, lower pain point on postoperative day 2, and reduced biliary drainage volume on both postoperative days 2 and 3 [6.0 (6.0, 7.0) d vs. 60.0 (56.0, 65.0) d, P<0.001; 3 (2, 4) vs. 4 (3, 5), P=0.007; 300 (200, 500) mL vs. 400 (300, 500) mL, P=0.016; and 300 (200, 400) mL vs. 410 (300, 600) mL, P=0.002]. No statistically significant differences were found between the EANBD and T-tube drainage groups regarding bile leakage (3 cases vs. 2 cases, P=0.895), intra-abdominal infection/abscess (1 case vs. 0 case, P=0.471), electrolyte metabolism disorders (4 cases vs. 11 cases, P=0.090), residual stones (1 case vs. 2 cases, P=1.000), or accidental tube dislodgment (3 cases vs. 1 case, P=0.531). During the 6-month postoperative follow-up, 95 patients (follow-up rate was 78.5%) underwent abdominal ultrasound or magnetic resonance cholangiopancreatography re-examination, and no complications such as biliary strictures were observed. ConclusionsFor choledocholithiasis treated via LCBDE, EANBD after operation shows advantages such as postoperative lower pain pionts, shorter indwelling tube duration. It serves as a safe and effective alternative to T-tube drainage in selected patients, which can shorten the indwelling tube duration and improve patients’ quality of life.