Patient Shi, a 65-year-old female, was admitted to the hospital in May 2008 with “gallbladder stones and cholecystitis” due to recurrent right upper abdominal pain for more than 10 years. After active preoperative preparation, LC cholecystectomy was performed under general anesthesia on June 3, during which the common bile duct was considered to be potentially damaged and the operation was transferred to open surgery. After careful exploration, the lower common hepatic duct was found to be transected and the internal diameter of the common bile duct was about 9 mm, so the gallbladder was resected, the common hepatic duct was flushed, and the common bile duct was explored and end-to-end anastomosis was performed after repairing the severed end of the common hepatic duct. An 18-gauge “T” tube was placed in the common bile duct, and the proximal end crossed over the dissection of the common hepatic duct. The common bile duct incision was sutured and water was injected into the “T” duct to check the density of the anastomosis, which could withstand the bulging tension of 20 ml of saline without leakage. After the operation, anti-inflammatory treatment was given, and the “T” tube was discharged ten days after the operation, and the “T” tube was removed after 6 months. There was no bile leakage, anastomotic stenosis or biliary obstruction at 2 years follow-up. The incidence of restenosis rate of restricture after surgery for medical bile duct stenosis has increased from 10% to 30%, and the injury often occurs at the bile duct confluence and above, especially in patients with improper management, where the proximal bile duct is easily retracted into the liver parenchyma during surgical repair of the stenosis, making the surgery more difficult. In cases of bile leak after surgery, immediate repair is not recommended. It is advisable to place a catheter for external drainage and then consider repair after 6 months. The repair and reconstruction of the biliary tract is a more complex and extensive problem. There are many methods to repair bile duct injuries, the most common method is bile-intestinal anastomosis. Since this method is prone to cause episodic biliary tract infection and bring health hazards to patients in the future, whether there are other surgical alternatives has become a question that clinicians should think deeply about. The main repair surgical procedures are: 1. The damaged bile duct is fully freed, incised, shaped and reanastomosed. Surgical steps: reveal the upper and lower ends of the injured bile duct segment, trim the injured bile duct segment and its surrounding tissues, the injured bile duct segment can generally be excised for 1 to 2 cm, and the bare area of the liver can be freed to move down when needed, or the head of the pancreas and duodenum can be freed again to reduce the anastomotic tension, the upper and lower severed ends of the bile duct can be slightly freed and trimmed, thoroughly stop bleeding, and carefully anastomose the bile duct. 2. Repair of bile duct with tipped jejunal flap. According to the size of the bile duct wall defect. A small section of jejunal collaterals with vascular tips was taken at 15 cm from the flexural ligament, and the jejunal-like mesentery was freed and transposed to the bile duct defect to form a jejunal flap with vascular tips, and then the jejunal flap was trimmed according to the area of the bile duct defect so that it was slightly larger than the area of the defect, and the mucosa of the jejunal flap was carefully anastomosed to the lumen of the bile duct, and the T-tube was supported through the anastomosis. 3.hepatic circular ligament (umbilical vein) patch to repair the bile duct defect. The hepatic round ligament is cut near the umbilicus and its proximal end is freed to the transverse hepatic fissure. According to the area of the bile duct defect, the lumen of the closed umbilical vein is appropriately dilated and cut longitudinally. The proximal lumen was closed with silk sutures, and the umbilical vein flap was trimmed and moved to the bile duct defect, with the endothelium facing the bile duct lumen and carefully anastomosed, and the T-tube supported through the anastomosis. 4.The bile duct defect was repaired using a flap made from the gallbladder wall. The common bile duct was ligated at about 0.5 cm from the common bile duct, the cystic duct was cut off, the gallbladder artery was preserved, the gallbladder was freed from the gallbladder bed and cut longitudinally to make a gallbladder flap with a vascular tip, trimmed to a size slightly larger than the area of the bile duct defect, moved to the defect, the mucosa was sutured to the bile duct lumen, and the T-tube support was left in place. 5, Repair of hepatobiliary duct defect with tipped anterior gastric sinus wall plasma muscle layer flap. Firstly, a vascular branch on the small curved side of the gastric sinus is selected, and according to the size of the bile duct defect, a plasma muscle flap slightly larger than the bile duct defect is cut in the gastric sinus according to the distribution of this vascular branch, and the plasma membrane of the flap is turned over to face the bile duct lumen, and the repair is intermittently sutured, and the T-tube is left to support the repair. Technical points: 1, ensure the blood flow of the tissue flap with the tip to prevent distortion and excessive stretching of the vascular tip. 2. Interrupted repair with fine silk sutures, paying attention to the mucosal counterpart, with the knot tied on the outside to ensure the smoothness and neatness of the inner wall of the repaired bile duct. 3.A u-tube or T-tube is placed in the repaired lumen to support the bile duct and drainage of bile for 6-9 months. In order to prevent the occurrence of restenosis at the repaired bile duct after surgery. 4.Establish smooth and effective abdominal drainage to ensure timely drainage of bile in case of postoperative bile leak. The main factors that cause stenosis after bile duct to end anastomosis are: the construction of the bile duct wall, the role of bile acid components in bile [1], the diameter of the bile duct, the influence of sutures [2], etc., among which the factors of anastomosis method and healing process are the most important. Bile duct butt-end anastomosis is mostly performed with a single layer of interrupted sutures. The scar proliferation and contracture of the wound surface during the healing process of the anastomosis after its end-end reconstruction is based on a series of activities of inflammatory cells, repair cells and various cytokines. And scar formation is a pathophysiological process of traumatic tissue healing [3]. After bile duct injury, fibroblasts at the injury site undergo phenotypic changes, functional activation and massive proliferation, and transform to myofibroblasts, which continuously produce a large amount of collagen and other extracellular matrix, resulting in fibrous thickening and scar formation at the injury site. To avoid postoperative biliary stricture, the main intraoperative anastomosis should be meticulous and monolayer to minimize foreign body irritation; drainage should be unobstructed to reduce biliary tension; the anastomosis should be loose and tight; hemostasis in the operative field should be thorough; and the anastomosis should have good blood flow, etc. Bile leakage is mostly seen in the early stage. It may be caused by sediment-like bile obstructing the T duct, or by roundworms entering the bile duct or even the T duct, resulting in blockage of drainage. If intestinal roundworms are suspected, it is advisable to expel roundworms within one week after surgery, and a little vinegar can be injected into the stomach tube in the early stage.