Primary intrahepatic stones are common in East Asia. These stones often reform within the ducts causing recurrent attacks of cholangitis and lead to ductal dilatation, strictures, and liver atrophy. The advancement in therapeutic endoscopy and interventional radiology has revolutionized the conventional surgical management of intrahepatic stones. Endoscopic drainage of the infected segment obviates the need of emergency surgical exploration. Stone clearance can be achieved by endoscopic retrograde cholangiopancreatography, percutaneous transhepatic choledochoscopy, or combined approaches. Extracorporeal shockwave lithotripsy will be helpful in difficult cases. Surgical resection and biliary reconstruction are now reserved for selected patients.