Nonoperative management in the form of percutaneous and ERCP therapy for biliary injury can be used as a deni­tive treatment or as a temporary management. ERCP, sphinc­terotomy, balloon dilatation, and stenting were a successful denitive treatment in about 82% of patients with bile duct injury but without transection and 80% of patients with pos­tcholecystectomy MBD stricture [32]. Denitive operative reconstruction should be performed under optimal condi­tions [21]. Operative management remains the gold standard for repair of iatrogenic biliary injury when complete MBD transections and occlusions present and injury cannot be managed with ERCP.Simple repair over a T tube is appropri­ate for non-thermal injuries involving less than 50% of the diameter of the CBD and for small lateral sidewall injuries [38]. Primary end to end tension free anastomosis is possible in case of sharp transection injury without involvement of hepatic duct conuence and no signicant tissue loss [39]. The gold standard for operative repair of iatrogenic MBD injury is a hepaticojejunostomy with 70 cm Roux limb to minimize the risk of enteric reux. Lowering the hilar plate allows easier identication of the left and right hepatic ducts [40]. Anastomotic strictures are reported in 4%–38% of patients who underwent hepaticojejunostomy with a revision rate of 20–25% [19, 29]. Liver resection and transplantation may be necessary [29]. Concomitant vasculo-biliary injury and lesions proximal to the hepatic duct conuence are the signicant risk factors for such sequalae [28].