Abstract: Objective To observe the effect of Bacillus coagulans live tablets combined with Smectite powder treatment after laparoscopic cholecystectomy diarrhea and effect on intestinal microflora and intestinal barrier function. Methods One hundred and twenty patients of laparoscopic cholecystectomy with diarrhea were randomly divided into observation group 60 cases and control group 60 cases from May 2014 to June 2018, control group was given smectite powder, the observation group was treated with Bacillus coagulans live tablets, 2 groups were treated for two weeks. The changes of total clinical symptom scores, intestinal flora and intestinal mucosal barrier function were observed before and after treatment. Results The stool frequency, stool and abdominal discomfort symptoms of two groups improved after treatment, the total effective rate of observation group was 91.7% (55/60), the control group was 71.7% (43/60), the efficacy of the observation group was more significant than the control group (χ²=9.186, P=0.010). After treatment, the Escherichia coli and enterococci in the observation group decreased significantly compared with those before treatment (P<0.05), and significantly lower than those in the control group (P<0.05). The number of Lactobacillus and Bifidobacteria in the observation group increased significantly (P<0.05), and significantly higher than that in the control group (P<0.05). After treatment, the serum D-lactate index in the two groups was significantly lower than that before the treatment, and the decrease in the observation group was more obvious than that in the control group (P<0.05). The level of sIgA in the two groups was significantly higher than that before treatment (P<0.05), and the sIgA level of the intestinal tract in the observation group was significantly higher than that of the control group (P<0.05). Conclusion Bacillus coagulans live tablets combined with Smectite powder treatment can significantly relieve the clinical symptoms after laparoscopic cholecystectomy in patients with diarrhea, which may be related to its regulation in patients with intestinal microecological balance and promote the epithelial barrier function of intestinal mucosa repair.