Hepatolithiasis, or primary intrahepatic stones, is prevalent in the Far East. The majority of primary intrahepatic stones were calcium bilirubinate stones 30-40 years ago in Korea. However, intrahepatic stones with high cholesterol purity have recently been recognized. Since 1990s, mixed stones constituting about 40-50% of all intrahepatic stones, and pure intrahepatic cholesterol stones have been observed in Korea. Although advances in interventional radiological techniques, cholangioscopic technique, and novel surgical technique have led to significant changes in treating the patients with hepatolithiasis, it is still considered as an intractable disease and more common in Korea than western countries. Therefore, Korean gastroenterologists should have more interest and accomplish passionate researches on hepatolithiasis.