Objective To investigate the clinical effect of laparoscopic versus open hepatectomy in the treatment of patients with regional hepatolithiasis. Methods A total of 87 patients with regional hepatolithiasis who were admitted to The First People's Hospital of Xianyang from January 2010 to June 2017 were enrolled. Among these patients, 38 underwent laparoscopic hepatectomy ( laparoscopic group) and 49 underwent open hepatectomy ( open group) . Propensity score matching was conducted to balance confounding factors between the two groups and then the perioperative indices were compared between the two groups. The t-test was used for comparison of continuous data between groups, and the chi-square test or Fisher's exact test was used for comparison of categorical data between groups. Results A total of 27 pairs of patients were matched successfully. There were no significant differences between the two groups in the type of hepatectomy, a combination with common bile duct exploration, rate of intraoperative hepatic portal occlusion, time of operation, rate of intraoperative blood transfusion, intraoperative stone clearance rate, total postoperative complications, and incidence of serious complication ( all P > 0. 05) .Compared with the open group, the laparoscopic group had significantly lower intraoperative blood loss ( 126. 4 ± 18. 7 ml vs 143. 2 ± 24. 1 ml, t = 2. 862, P = 0. 006) and shorter length of hospital stay ( 11. 7 ± 2. 3 d vs 13. 4 ± 1. 9 d, t = 2. 961, P = 0. 004) . Conclusion Laparoscopic hepatectomy has a comparable clinical effect to open hepatectomy in the treatment of regional hepatolithiasis and has the advantages of low intraoperative blood loss and rapid postoperative recovery.