Background and Aims: Hepatolithiasis is a complicated pathological condition, with a high postoperative recurrence rate, requiring repeated operations. In the late course of the disease, biliary cirrhosis and even intrahepatic cholangiocarcinoma may occur, which seriously affect the patients’ quality of life. This study was conducted to investigate the safety and efficacy of biliary flap transposition hilar biliary stricture repair in treatment of hepatolithiasis.  
Methods: The clinical data of 36 patients with hilar biliary stricture treated in Hunan Provincial People's Hospital from January 1, 2016 to December 31, 2018 were retrospectively analyzed. The clinical variables that included the operative time, intraoperative blood loss, hospitalization time, postoperative complications, and anastomotic restenosis observed. 
Results: Of the patients, 8 cases had the initial surgery, and the other 28 cases had surgery such as cholecystectomy, and common bile duct exploration once to 4 times previously. All patients underwent hilar biliary stricture repair by biliary flap transposition, and biliary basin Roux-en-Y internal drainage. Meanwhile, 3 cases underwent the right posterior lobe resection, 6 cases underwent the left lateral lobe resection, and 11 cases underwent the quadrate lobe resection. No perioperative death occurred. The average operative time was (256.4±98.2) min, the average intraoperative blood loss was (218.5±68.1) mL, and the average length of hospital stay was (10.3±3.2) d. After operation, residual stones were found in 3 cases (8.3%), mild bile leakage occurred in 1 case, partial intestinal obstruction occurred in 1 case, abdominal fluid collection occurred in 2 cases, and pleural effusion occurred in 2 cases, which were all resolved by conservative treatment, and no complication greater than Clavien-Dindo IIIa was noted. All patients were followed up by outpatient examination and telephone interview. The median follow-up time was 23.6 (12–46) months. Reflux cholangitis occurred in 2 patients, which were spontaneously resolved, and no anastomotic restenosis was found. Stone recurrence was found in 3 cases (8.3%).
Conclusion: Biliary flap transposition hilar biliary stricture repair is safe and effective for the treatment of hepatolithiasis, and it can be used for reference in clinical paractice.