Background: Bile duct injury (BDI) is one of the most serious complications of cholecystectomy associated with substantial risk of morbidity and mortality. Although surgical techniques have evolved, bile duct injuries continue to occur with notable frequency.

Aim: To evaluate the demographic profile, presentation, classification, management, and outcomes of patients with BDI following laparoscopic cholecystectomy.

Methods: A dual center prospective study was conducted from June 2022 to June 2024 at Jawaharlal Nehru Medical College, Aligarh and Sir Ganga Ram Hospital, New Delhi. Sixty patients with post laparoscopic cholecystectomy BDI were included. Data were collected on demographic profile, clinical features at presentation, Strasberg–Bismuth classification, management, post operative complications and overall outcome at six months.

Results: The mean age was 38.1 years with female predominance (F:M ratio 2.3:1). Common symptoms were abdominal pain (81.7%) and jaundice (73.3%). Injuries were most frequently Strasberg class E4 (25%) and E2 (23.3%), followed by class A (23.3%). Hepaticojejunostomy was performed in 75% of patients, ERCP with sphincterotomy in 16.7% (two failures) and 8.3% were managed conservatively. At six months, 93.3% of patients improved, while overall mortality occurred in 6.7% (n=4). Early postoperative symptoms including pain and icterus showed steady resolution, and most patients had satisfactory recovery.

Conclusion: BDI continues to challenge surgeons in the laparoscopic era, with complex injuries often managed at specialized centers. Hepaticojejunostomy remains the cornerstone of management for high-grade injuries, while ERCP offers effective minimally invasive approach for biliary leaks. Early recognition, accurate classification, and specialized multidisciplinary care are critical for optimizing outcomes and minimizing long-term complications.

Bile duct Injury, Cholecystectomy, Strasberg classification, Hepaticojejunostomy, ERCP