Injuries to the bile duct that are almost universally iatrogenic and may infrequently be due to trauma. The most common procedure causing a bile duct injury is the laparoscopic cholecystectomy. Historically the incidence of bile duct injury while performing an open cholecystectomy was as low as 0.1% to 0.2%, but with the introduction of laparoscopic cholecystectomy, the incidence has increased to 0.4% to 0.6% of patients. Any major bile duct injury may result in significant morbidity, increased mortality, and financial burden on the patient. These injuries should be prevented with meticulous technique and selective use of intra-operative cholangiography. The most common technique to repair major bile duct injuries is the Roux-en-Y hepaticojejunostomy (RYHJ)