Background: Hepatolithiasis is the presence of calculi in the intra-hepatic bile ducts. If left untreated, it may cause recurrent cholangitis, hepatic abscesses, cirrhosis, liver atrophy, or degeneration to cholangiocarcinoma. Morbidity increases in bilateral forms of presentation. It is thought that a transitory bactibilia stimulates the formation of lithiasis. This leads to a persistent bactibilia, and therefore increases the risk of cholangitis. The most commonly found micro-organisms in bile cultures are Escherichia coli, Klebsiella, Pseudomonas, and Proteus. Case Presentation: We present the case of a 67-year-old male with a finding of portal hypertension and bilateral hepatolithiasis discovered while studying a dissociated cholestasis. After several unsuccessful attempts for complete extraction of hepatolithiasis through conservative means (transparietohepatic approach, endoscopic retrograde cholangiopancreatography with endoscopic laser therapy) and because of recurrent episodes of cholangitis, a simultaneous surgical and endoscopic approach was undertaken (cholecystectomy with bile duct exploration and intra-operative laser therapy). The patient currently remains asymptomatic. Conclusion: The treatment of hepatolithiasis has evolved because of the increase in the number of non-surgical techniques such as endoscopic laser therapy. Currently a surgical approach implying cholecystectomy and bile duct exploration combined with endoscopic laser techniques could be the elective treatment option, allowing the prevention of hepatectomy especially in patients at elevated surgical risk and in bilateral cases of hepatolithiasis.