Objective To study the causes of abdominal distension in patients with hepatocellular carcinoma (HCC) after laparoscopic hepatectomy, and to explore the corresponding treatment countermeasures. Methods A total of 186 patients with HCC were treated by laparoscopic hepatectomy in our hospital from September 1, 2018 to August 31, 2020. Demographic characteristics [age, gender, body mass index (BMI), liver cirrhosis, child-Pugh classification of liver function], operative time, hilar occlusion time, intraoperative blood loss, scope of hepatectomy, postoperative visual analogue scale (VAS) score and serological indexes (hemoglobin, serum albumin, white blood cell count, platelet count, serum potassium level) were collected retrospectively. The occurrence of postoperative abdominal distension was observed, and the patients were divided into abdominal distension group and non abdominal distension group. The independent influencing factors of abdominal distension after laparoscopic hepatectomy were analyzed, and the corresponding treatment countermeasures were discussed. Results A total of 138 patients developed varying degrees of abdominal distension after operation (74.19%), including 45 cases of mild abdominal distension, 53 cases of moderate abdominal distension, and 40 cases of severe abdominal distension. They were all included in the abdominal distension group, and the occurrence time of abdominal distension was mainly 1-5 days after operation. Forty-eight patients (25.81%) had no abdominal distension after operation and were included in the non-abdominal distension group. Univariate analysis results show that: the proportion of patients with abdominal distension combined with liver cirrhosis was significantly higher than that of the non-abdominal distension group (47.10% vs. 25.00%, P=0.007), the operative time [(143.54±23.48) min vs. (129.45±24.51) min, P=0.001], hilar occlusion time [(18.02±8.12) min vs. (15.38±7.28) min, P=0.048] were significantly longer than those of the non-abdominal distension group, the postoperative VAS score was significantly higher than that of the non-abdominal distension group [5.12±1.14 vs. 4.47±1.05, P=0.004], and the serum potassium level was significantly lower than that of the non-abdominal distension group [(3.12±0.38) mmol/L vs. (3.67±0.42) mmol/L, P＜0.001]. Multivariate unconditional logistic regression analysis showed that patients with liver cirrhosis [OR=1.520, 95%CI (1.104, 2.093), P=0.010], serum potassium level ＜3.40 mmol/L [OR=1.684, 95%CI (1.203, 2.357) , P=0.002], operative time ＞136 min [OR=1.842, 95%CI (1.297, 2.616) , P=0.001], hilar occlusion time ＞16.7 min [OR=1.492, 95%CI (1.047, 2.126) , P=0.027], VAS score ＞5 [OR=1.498, 95%CI (1.021, 2.198), P=0.039] were independent risk factors of abdominal distension after laparoscopic hepatectomy. Conclusions The risk factors of abdominal distension after laparoscopic hepatectomy were liver cirrhosis, serum potassium level ＜3.40 mmol/L, operative time ＞136 min, hilar occlusion time ＞16.7 min and VAS score ＞5. More attention should be paid to high-risk patients and effective treatment measures should be taken in time to reduce the risk of abdominal distension after surgery. For patients with abdominal distension, we should take effective measures to alleviate the symptoms of abdominal distension and promote the recovery of patients with abdominal distension.