Thirty-eight cases of hepatolithiasis were treated by percutaneous transhepatic cholangioscopy (PTCS) from Oct. 1983 to Sept. 1987 at the Chang Gung Memorial Hospital. There were 20 males and 18 females, age distribution ranged from 18 to 85, with a mean of 44 year old. Those with a history of previous biliary operation for biliary calculi were the majority, representing 92.1% (35 cases) of patients. The location of the stones in 38 cases were: bilateral IHD in 11, right IHD in 14, left IHD in 13. Hepatolithiasis associated with intrahepatic duct or biliary-enteric anastomotic strictures occurred in 84.2% (32 cases). Those strictures were dilated by PTCS drainage catheter in 14 cases and by Gruntzig balloon catheter in 7 cases. Complete removal of hepatolithiasis by PTCS in 32 cases resulted in a success rate of 84.2%. The sessions of PTCS ranged from 1 to 18, or a mean of 5. Two cases had major complications during the course of PTBD and required a change to a PTCS catheter; one case had subphrenic hematoma which needed laparotomy, and another case had hemobilia with sepsis which resulted in mortality. Long-term follow-up results in 32 cases of successful PTCS in hepatolithiasis with a range from 3 to 7 years period were free of symptoms and without evidence of recurrent stones in 50% (16/32), free of symptoms with recurrent stones in 2 cases. Recurrent stones with cholangitis occurred in 10 cases and 2 cases had symptoms of cholangitis without evidence of recurrent stones.(ABSTRACT TRUNCATED AT 250 WORDS)