Objective To explore the operation methods and indications of the transabdominal reverse guided-laparoscopic endoscopic sphincterotomy in treatment of duodenal papilla stenosis during the course of laparoscopic common bile duct exploration. Methods The clinical data of 501 cases of duodenal papilla stenosis who underwent laparoscopic endoscopic sphincterotomy with the transabdominal reverse guide technique from March 2003 to July 2015 in the Second People’s Hospital of Chengdu city were analyzed retrospectively. Results All operation of the 501 cases were successful, no death happened. The operation time were 60-190 min (average of 107 min), the blood loss were 5-100 mL (average of 21.8 mL), and postoperative hospitalization time were 4-9 days (average of 6.7 days). It was successful in 501 cases that removed the gallbladder, and successful in 493 cases (98.4%) that removed the common bile duct stones out of 501 cases. Six cases (1.2%) had residual stones in T tube drainage and received treatment with postoperative choledochoscope and electrohydraulic lithotripsy. Two cases (0.4%) of primary suture had residual stones. In the 501 cases, 364 cases (72.7%) underwent directly implementation of primary suture after the success of papillary stenosis cutting, 9 cases (1.8%) underwent primary suture after indwelling ureteral catheter, 118 cases (23.5%) underwent primary suture after detaining nasobiliary drainage, 4 cases (0.8%) failed in cutting the papillary stenosis and 6 cases (1.2%) had residual stones, all the 10 cases turned into the T tube drainage. After the operation, 9 cases (1.8%) suffered from mild pancreatitis and 23 cases (4.6%) suffered from bile leakage, no perforation of intestine and bile duct, bleeding, severe pancreatitis, and other complications happened. The overall incidence of postoperative complication was 6.8% (34/501). Conclusion If patients are suitable, transabdominal reverse guided-laparoscopic endoscopic sphincterotomy in treatment of duodenal papilla stenosis is safe and effective.