PURPOSE: Intrahepatic duct stone (IHD) disease, especially bilateral lesion, is difficult to management for complete cure. The purpose of this study is to analyze the clinical manifestations and treatment outcomes and is to consider adequate strategy of treatment between unilateral and bilateral IHD stones. METHODS: From October 1993 to July 2004, 218 patients with IHD stone were performed by surgical management at Ewha Womans University Mokdong Hospital. The medical records of these patients were reviewed retrospectively. We classified into two groups, such as unilateral group (U group) and bilateral group (B group), and compared two groups for clinical manifestations and outcomes. RESULTS: Of the 218 IHD stone patients, 188 cases underwent conventional open surgery, 20 cases underwent laparoscopic surgery, and 10 cases underwent laparoscopic assisted surgery. U group and B group was composed 162 and 56 cases, respectively. IHD stones were more common in left lobe of liver than right lobe in U group (P<0.001). IHD stricture were more common in U group (P=0.048). On the other hand, remnant stones were more common in B group (P<0.001). There was no statistical significance for postoperative complication and method of operation include liver resection between two groups. CONCLUSION: We presume that the pathogenesis may be different between unilateral and bilateral IHD stone. To cure or reduce the remnant stone rate, more aggressive treatment such as liver resection should be also considered in the patients with bilateral as well as unilateral IHD stone because of no difference of complication rate of two groups.