Purpose: Laparoscopic common bile duct exploration (LCBDE) and endoscopic retrograde cholangiopancreatography (ERCP) are commonly used for common bile duct (CBD) stone removal, but the optimal approach remains debated. This study compares outcomes between LC with LCBDE and ERCP followed by LC within a regional Australian healthcare setting. Methodology: A retrospective study from January 2020 to December 2024 analyzed 193 patients with choledocholithiasis who underwent LC in Cairns Hospital. Patients were categorized into two groups: LC+LCBDE (n=70) and ERCP+LC (n=123). Data collected included CBD clearance rates, postoperative complications and long-term outcomes. Results: Among 193 patients, baseline characteristics were comparable between the groups. Emergency procedures accounted for 92.9% of LC+LCBDE cases. Initial CBD clearance success was higher in the ERCP+LC group (83.2%) compared to LC+LCBDE (64.3%) (p=0.003). ERCP+LC required more procedures on average (2 vs. 1, p<0.001) but had a shorter operative time (89 min vs. 131.5 min, p<0.001). Complication rates were low and comparable (7.1% in LC+LCBDE vs. 9.8% in ERCP+LC, p=0.046). One mortality was reported in the ERCP+LC group. Conclusion: ERCP followed by LC had a higher initial success rate for CBD clearance compared to LC+LCBDE but required more procedures. Both techniques demonstrated low complication rates, highlighting their safety and effectiveness in managing CBD stones. Further studies are required to determine the optimal approach.