Objective To investigate the relationship between cholecystectomy and the subsequent occurrence of primary choledocholithiasis and to review the surgical treatment of primary choledocholithiasis. Methods The clinical data of 70 patients with forward common bile duct stones after cholecystectomy who were admitted to our hospital from January 2007 to December 2013 were retrospectively analyzed. Results All 70 patients underwent open surgery for removal of common bile duct stones, which were identified as bile pigment calculi. The postoperative complications included incisional wound infection (8 cases) and lung infection (5 cases) , and no severe complications as biliary leakage or hematobilia were observed. All patients fully recovered at the time of discharge. Eight cases of recurrent common bile duct stones were found and surgeries were performed 2. 5 to 4 years after the recurrence. All patients were cured by choledocholithotomy, common bile duct transection, and Roux- en- Y hepaticojejunostomy. Conclusion Primary choledocholithiasis is an age- related disease, not a long- term complication of cholecystectomy. If no bile duct injury occurs during the cholecystectomy, the incidence rate of primary choledocholithiasis will not be increased. Surgical treatment is required for primary choledocholithiasis. For the cases of choledochectasia with the diameter of common bile duct greater than 2. 5 cm or recurrent choledocholithiasis, the laparotomy with common bile duct transection and Roux- en- Y anastomosis is recommended.