Background : Hepatolithiasis is a significant biliary disorder in Bangladesh, leading to considerable patient morbidity and necessitating effective surgical interventions.

Methods : This prospective study was conducted from January 2018 to December 2023 at the Department of HBP Surgery, Bangabandhu Sheikh Mujib Medical University, Central Hospital and BIRDEM Hospital, Dhaka. A total 62 patients diagnosed with hepatolithiasis enrolled and categorized into open surgery (n=35) and minimally invasive surgery (n=27) groups. Surgical outcomes, including stone clearance rates, postoperative complication incidences, length of hospital stay, were systematically recorded. Data were analyzed using SPSS version 26.0, employing chi-square tests for categorical variables and t-tests for continuous variables. Logistic regression was performed to identify predictors of postoperative complications

Results : Among 62 patients, stone clearance achieved in 32 (91.4%) of open surgery group 25 (92.6%) of minimally invasive group (p=0.85). Open surgery group experienced higher incidence of postoperative complications (15%) compared to minimally invasive group (5%) (p=0.04). Mean length of hospital stay was significantly longer for open surgery patients (10 ± 2 days) versus those undergoing minimally invasive procedures (5 ± 1 days, p<0.001). Logistic regression analysis revealed minimally invasive surgery independently associated with reduced postoperative complications (Odds Ratio = 0.25, 95% CI: 0.07-0.90, p=0.035). Additionally subgroup analysis indicated that laparoscopic approaches specifically resulted in a 35% reduction in hospital stay and a 40% decrease in complication rates compared to open surgery

Conclusions : Minimally invasive surgical approaches for hepatolithiasis in Bangladeshi tertiary care institutions demonstrate comparable stone clearance rates, significantly lower complication incidences, and shorter hospital stays compared to open surgery.