In recent years, with the widespread implementation of new procedures such as laparoscopic cholecystectomy (LC) and small incision cholecystectomy (MO), the incidence of medically induced bile duct injuries has increased significantly compared to the previous ones. In LC, for example, the incidence of IBDI caused by it (0.4%C1.4%) reaches two to seven times that of conventional cholecystectomy, and the degree of injury is more severe than the latter [1]. The bile duct is characterized by fine and delicate structure and poor self-repair ability, which makes the complications caused by IBDI such as biliary fistula, biliary stricture and recurrent cholangitis always a problem in abdominal surgery. Therefore, the problems related to IBDI should be highly valued by clinicians, and this paper only briefly discusses the classification and treatment of IBDI. 1, injury classification The ideal IBDI classification method can not only be used to distinguish different degrees of bile duct injury and guide the determination of the corresponding treatment plan, but also be used to assess the prognosis, compare the efficacy, and facilitate academic exchange and statistical analysis of the literature. However, at present, although there are more classification methods about biliary tract injury at home and abroad, they fail to reach a unified consensus. Some flow too simple and incomplete, while others are too detailed and complex to remember [2]. Most of these classification methods are based on the site of injury, while a few are based on the cause of the injury. Currently, the most commonly used internationally is the Bismuth classification Strasberg classification. 1, 1Bismuth classification method type I: left and right hepatic duct confluence below the common hepatic duct or bile duct stump length ≥ 2 cm; type II: left and right hepatic duct confluence below the common hepatic duct stump length 5 mm small laceration of the bile duct (8 mm; injury site below the confluence of left and right hepatic duct. For large defects that cannot be repaired or anastomosed at the opposite end, a bile duct jejunostomy is the ideal procedure, and the proximal bile duct can be appropriately incised longitudinally to enlarge the anastomosis; if the local conditions are very poor, then adequate drainage has to be left for stage II treatment. It should be emphasized that regardless of bile duct-to-terminal anastomosis or bile duct jejunostomy Roux-en-Y anastomosis, it is necessary to ensure tension-free anastomosis, mucosa-to-mucosa, reasonable trimming and shaping after full circumferential anastomosis of the opposite end and placement of T-tube support and drainage to prevent postoperative anastomotic stenosis. Proper first treatment after bile duct injury has a great impact on the patient’s prognosis and the degree of difficulty of reoperation, so great care should be taken to strictly master the principles and timing of the first treatment to prevent restenosis and serious complications. If the technical conditions are not available or inexperienced for the first operation, do not take the risk, and timely transfer to hospital for treatment is the best policy. 2.2 Postoperative management 2.2.1 Management of early postoperative injury If signs of biliary tract injury appear in the early postoperative period, the patient is in good general condition, and the local inflammation is not heavy, stage I repair or bile-intestinal Roux-en-Y anastomosis can still be done with perioperative supportive therapy and antibiotic application. The key is the duration of “early”, which varies from 48 hours to 1 week. The author believes that the principle of “individualized” should be strictly adhered to. If the patient is in poor condition, or if the bile leak is found late and the local conditions are poor, the bile duct and abdominal cavity should be adequately drained first, and biliary reconstruction should be considered after 4-6 weeks when the inflammation subsides. Some foreign scholars [6] also believe that waiting for more than 6 weeks will cause dense adhesions to form in the injured area, thus making it more difficult for repair surgery, and therefore advocate that repair surgery can be performed as soon as the abdominal infection is resolved. 2,3 Management of late biliary strictures The timing of surgery for postoperative complete biliary obstruction biliary reconstruction is also controversial. If it is too early, the bile duct above the obstruction will be thin and prone to stenosis after reconstruction; if it is too late, liver function will be seriously damaged and healing will be affected. Here, liver function is the “weight” in deciding whether to operate or not. It is generally believed that after 4 weeks of injury, when ultrasound or CT indicates bile duct dilatation ≥15 mm, reconstruction is more appropriate, which can ensure that the anastomosis is large enough to avoid the occurrence of anastomotic stenosis. Incomplete biliary obstruction is often combined with severe biliary tract infection, and the appropriate timing of surgery should be chosen in the interval between episodes of cholangitis. Roux-en-Y bile duct jejunostomy is the most commonly used reconstructive procedure with the most positive outcome. There are many factors associated with the failure of biliary reconstruction surgery, the more important of which are: cholangitis following biliary injury, strictures above the confluence of the right and left hepatic ducts, etc. In addition, disruption of biliary blood flow is also a factor that cannot be ignored. A recent study [9] showed that the application of hepatic segmental resection + intrahepatic bile duct jejunostomy for IBDI avoids the effect of biliary blood flow destruction and has better efficacy than extrahepatic bile duct jejunostomy. The success rate of reconstruction by professionals is high, but it is also affected by the number of previous re-repairs, so a good first reconstruction is crucial. In recent years, with the development and improvement of endoscopic, imaging, interventional and other technical equipment, new initiatives and hopes have been offered for the management of IBDI. For example, the application of nasobiliary drainage (NBD) to close the bile duct stump leak [10], endoscopic or X-ray placement of catheters and balloon dilation for bile duct injury strictures [11], etc. Today’s hepatobiliary surgeons must be able to integrate these therapeutic approaches with surgical treatments when dealing with IBDI in order to develop a reasonable comprehensive treatment plan, but always keeping in mind that good prevention is the best way to deal with IBDI. As summarized by Y.H. Liu [12]: emphasize the importance of implementing avoidance and preventive measures by all means before the occurrence of biliary tract injury; completing effective and timely treatment once injury occurs before complications occur; completing necessary reoperation after complications occur before the formation of injurious biliary strictures; and completing definitive treatment after the formation of injurious biliary strictures before irreversible liver damage occurs to the patient.