Objective To explore the application value of digital intelligent diagnosis and treatment technology in the diagnosis and treatment of hepatolithiasis following multiple biliary tract operations. Methods A retrospective cohort study was carried out to enroll patients with a history of biliary duct surgery who underwent choledochoscopy combined with hard lithotomy at Zhujiang Hospital of Southern Medical University between January 2017 and December 2024. These patients were then divided into the 3DVT-FI group and the conventional surgery group. Subsequently， the clinical data of the two groups were collected， analyzed， and compared. Results A total of 63 patients were included， with 33 in the 3DVT-FI group and 30 in the conventional surgery group. After inverse probability of treatment weighting （IPTW）， there was no statistically significant difference in the general data （P > 0.05）. The laparotomy rate， intraoperative blood loss， postoperative complication rate， and reoperation rate within 3 months in the 3DVT-FI group were significantly lower than those in the conventional surgery group （all P < 0.05）. Univariate analysis showed significant differences between the groups with and without postoperative complications in terms of the presence of extrahepatic bile duct stones， year of surgery， and surgical approach （P < 0.05）. Multivariate analysis indicated that the absence of extrahepatic bile duct stones （OR = 0.105） was a protective factor against postoperative complications， whereas the conventional surgical approach （OR = 3.952） was a risk factor （all P < 0.05）. Conclusions The application of 3D visualization in combination with ICG fluorescence imaging technology in the diagnosis and treatment of hepatolithiasis following multiple biliary tract operations can enhance the rate of minimally invasive procedures and decrease the incidence of postoperative complications. The utilization of this technology can improve the safety and effectiveness of surgical treatment for hepatolithiasis in patients with a history of multiple biliary tract operations， which shows significant clinical value.