Abstract: Objective:To explore the difficult causes and the practicable approach during laparoscopic cholecystecomy(LC).Methods:Forty-eight cases performed difficultly LC were analyzed retrospectively the preoperative clinical data,the intraoperative difficulties and strategies.Results:Among 48 cases,46 cases with the successful LC,2 cases transited to the open-cholecystectomy.In the perioperative period,1 case suffered from the biliary leakage undergone a second surgery exploration,and the reason was conformed to be linked with the fall off-titanium clamp.After the process of the ligation of bile duct,peritoneal rinse with saline and the placement of the drainage tube,the patient was cured without long-term complications.Conclusions:Multiple causes are linked with the difficult LC.It might be helpful to reduce the transition to the interim abdominal open and severe complications by the comprehensive clinical assessment and careful preparations before the operation,and the choice of appropriate management strategies and the accurate grasp of transit open indications in the perioperative period.