Objective To compare the efficacy of saline irrigation following mesh basket lithotripsy and mesh basket combined with balloon lithotripsy for choledocholithiasis. Methods Data of 76 patients who received endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis in Henan Provincial People""s Hospital from May 2021 to May 2023 were retrospectively analyzed. Among them, 30 patients underwent saline irrigation of the biliary tract after mesh basket lithotripsy (the saline group), while 46 patients underwent mesh basket combined with balloon lithotripsy (the balloon group). The procedure success rate, operation time, procedure cost, and incidence of postoperative complications were compared. Results The stone extraction success rates were 100.0% in both groups. The operation time in the saline group was shorter than that in the balloon group [20.0 (16.0, 27.5) min VS 29.0 (22.0, 33.3) min, Z=-2.88, P=0.004]. The procedure cost in the saline group was lower than that in the balloon group [13 466.5 (13 318.0, 13 784.0) yuan VS 16 209.0 (15 989.0, 16 327.8) yuan, Z=-6.37, P<0.001]. There was no significant difference in the incidence of postoperative fever, cholangitis or pancreatitis between the two groups (P>0.05). Conclusion Compared with mesh basket combined with balloon lithotripsy, saline irrigation of the biliary tract after mesh basket lithotripsy can shorten the operation time, reduce the procedure cost, and maintain a high procedure success rate for treating choledocholithiasis.