Objective: To investigate the rational selection of surgical approaches for hepatolithiasis with different classifications. Methods: The clinical data of 667 hepatolithiasis patients undergoing surgical treatment from January 2005 to December 2012 were retrospectively analyzed. Patients underwent a single procedure or combined procedures of bile duct exploration (BDE), hepatectomy (HT), and hepaticojejunstomy (HJS). After classification by the classification method, the stone clearance rate, incidence of postoperative complications and excellent follow-up rate were compared among different surgical approaches for the same type of hepatolithiasis. Results: In the 129 type I patients, the stone clearance rate and excellent follow-up rate after HT and BDE+HT were better than those after other procedures (all P<0.05), while no difference was found in incidence of postoperative complication among the procedures (P>0.05). In the 72 type IIa patients, stone clearance rate and excellent follow-up rate after BDE+HT were better than those after other procedures, while BDE+HJS showed the lowest incidence of postoperative complications (all P<0.05). In the 98 type IIb patients, the stone clearance rate and excellent follow-up rate were the highest after BDE+HT, while HT had the highest incidence of postoperative complications (all P<0.05). In the 25 type IIc patients, no difference in any of the parameters was noted among the procedures (all P>0.05). In the 251 type Ea patients, both stone clearance rate and excellent follow-up rate after BDE+HT were better than those after other procedures, while the incidence of postoperative complications after BDE was lower than that after other procedures (all P<0.05). In the 55 type Eb patients and the 37 type Ec patients, the stone clearance rate and excellent follow-up rate after BDE+HT+HJS were better than those after other procedures (all P<0.05), while no difference in postoperative complications was observed among the procedures (all P>0.05). Conclusion: Based on the rational selection of surgical approaches according to the classification of hepatolithiasis, and with appropriate adjuvant treatments, the tailored and individualized therapy is helpful to improve stone clearance rate and reduce postoperative complications.