Background and Aims Patients with a history of upper abdominal surgery often present with increased difficulty and surgical risk during laparoscopic common bile duct exploration (LCBDE) because of intra-abdominal adhesions, altered anatomical structures, and difficulties in exposing the biliary tract. Indocyanine green (ICG) fluorescence imaging may facilitate intraoperative bile duct localization; however, its clinical utility in these patients remains unclear. This study aimed to evaluate the clinical utility of ICG fluorescence imaging-assisted laparoscopic common bile duct exploration in patients with common bile duct stones and a history of upper abdominal surgery.Methods The clinical data of patients with common bile duct stones and a history of upper abdominal surgery who underwent LCBDE at the First Affiliated Hospital of Nanchang University between May 2019 and June 2024 were retrospectively analyzed. Patients were divided into an ICG group and a non-ICG group according to whether ICG fluorescence imaging was used during operation. The primary outcomes assessed included bile duct identification time, operative time, intraoperative blood loss, intraoperative complications, conversion to open surgery, bile duct management method, postoperative length of stay, postoperative complications, residual stones, and stone recurrence.Results A total of 178 patients were included, comprising 64 in the ICG group and 114 in the non-ICG group. No statistically significant differences in baseline characteristics were observed between the two groups. Successful bile duct fluorescence visualization was achieved in 58 of 64 patients in the ICG group (90.6%). Compared with the non-ICG group, the ICG group had shorter median bile duct identification time, shorter operative time, and less intraoperative blood loss [20.00 (15.00-25.00) min vs. 50.00 (31.25-60.00) min, P<0.001; 157.50 (130.00-210.00) min vs. 190.00 (146.25-260.00) min, P=0.005; and 50.00 (50.00-100.00) mL vs. 100.00 (50.00-200.00) mL, P=0.002, respectively]. No statistically significant differences were observed in intraoperative complications, conversion to open surgery, bile duct management method, postoperative length of stay, postoperative complications, residual stone rate, or stone recurrence rate between the two groups (all P>0.05).Conclusion In patients with common bile duct stones and a history of upper abdominal surgery, ICG fluorescence imaging-assisted LCBDE was associated with shorter bile duct identification and operative times and less intraoperative blood loss. ICG fluorescence imaging may facilitate bile duct localization and intraoperative manipulation in patients with complex abdominal anatomy. Its effects on postoperative and long-term outcomes warrant further investigation.