Objective: To compare the efficacies of anatomic and nonanatomic hepatectomy for hepatolithiasis. Methods: The clinical data of 61 patients with hepatolithiasis undergoing hepatectomies were retrospectively analysed. Using a prospective, cohort-controlled design, 31 patients with hepatolithiasis underwent anatomic hepatectomy and the other 30 patients with hepatolithiasis underwent nonanatomic hepatectomy. The operative time, intraoperative blood loss, incidence of postoperative complications, postoperative aspartate transaminase (AST) level, postoperative drainage volume, time to flatus, length of postoperative hospitalization and residual stone rate of the two groups were compared. Results: There were no significant differences in the general condition, organs function, stone distribution, anatomic variation and scope of liver resection between the two groups before operation (all P>0.05). The intraoperative blood loss, incidence of postoperative complications, AST level and drainage volume were significantly reduced but the operative time was significantly prolonged in anatomic hepatectomy group compared with nonanatomic hepatectomy group (all P<0.05). No differences between the two groups were noted with regard to the time span for flatus, length of postoperative hospital stay and residual stone rate (all P>0.05). Conclusion: Anatomic hepatectomy has the advantages of minimum surgical trauma as well as reduced exudation and less complications. Although it currently requires longer operative time than nonanatomic procedure, its potentiality for improvement is possible. So it deserves to be widely performed.