Abstract:Background and Aims Laparoscopic common bile duct exploration (LCBDE) is a standard minimally invasive approach for choledocholithiasis. Although single-incision plus one-port laparoscopy (SILS+1) has demonstrated advantages in cholecystectomy, its safety and efficacy in common bile duct exploration remain unclear. This study aimed to compare perioperative outcomes between SILS+1 and conventional multi-port LCBDE under standardized adjunctive conditions including indocyanine green (ICG) fluorescence cholangiography and spontaneous biliary stent placement.Methods A retrospective analysis was conducted on 132 patients who underwent LCBDE between March 2024 and March 2025. Patients were divided into a SILS+1 group (n=32) and a conventional multi-port group (n=100). After propensity score matching, 32 patients in the SILS+1 group and 64 in the control group were included. Perioperative outcomes, postoperative recovery, complications, and cosmetic satisfaction were compared.Results There were no significant differences in operative time or bile duct suturing time between the two groups (both P>0.05). The SILS+1 group showed significantly shorter specimen extraction time, reduced total incision length, lower 24 h postoperative pain scores, and higher cosmetic satisfaction (all P<0.001). No significant differences were observed in intraoperative blood loss, hospital stay, total cost, or complication rates. All bile leakage cases were successfully managed conservatively without reoperation. No retained stones or stent-related complications were observed.Conclusion Under standardized adjunctive conditions, SILS+1 LCBDE is a safe and feasible technique that reduces surgical trauma, alleviates postoperative pain, and improves cosmetic outcomes without increasing complication rates. Further multicenter studies with long-term follow-up are needed to validate its clinical benefits.