In this study, 33 patients with post cholecystectomy bile duct injuries were assessed, of which 22 were females and 11 males. The ages of the patients ranged between 30 and 65 years. 4 patients were diagnosed intra -operatively while 23 patients were diagnosed in the post operative period. The time of presentation of patients diagnosed postoperatively varied significantly among the patients ranging from few days to 3 months. Twenty one patients were presented clinically with obstructive

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... with or without cholangitis. Two patients were presented with biliary peritonitis while 4 patients were presented with external biliary fistulae and 2 patients with an intra-abdominal collection. All patients were assessed through a thorough history taking and physical examination, in addition to complete laboratory work -up. Abdominal ultrasound was done as a routine primary investigation for all patients. It was very accurate in the detection of intrahepatic biliary dilatation and intraperitoneal collections and their aspiration. ERCP was successfully performed as a preoperative investigation with accurate results documenting the level of bile duct injuries, failure in one case; also it was successful in management of 9 cases. MRCP was done as a preoperative diagnostic tool for 8 patients. It showed excellent results in accurately specifying the level of the injury, and the degree of dilatation of the proximal biliary tree. PTC was a successful preoperative diagnostic tool in two patients, clearly delineating the proximal biliary tree and identifying the level of injury. PTC with external drainage of the biliary tree (PTD) was avoided to keep the advantage of finding dilated bile ducts in subsequent planned surgery shortly afterwards. Management depended largely on time of diagnosis. Patients were managed immediately. 12 patients were, managed by non -surgical treatment through ERCP or US guided drainage. 17 patients were managed by surgery by bilioentericanastomosis. The four patients diagnosed intraoperatively were managed immediately ,one patient with partial injury of the CBD at the level of the cystic duct was repaired primarily over a T -tube, another patient had completely transected CBD were repaired by end -toend anastomosis of the CBD on a T-tube and two patients had an immediate hepaticojejunostomy. Twelve patients were managed non -surgically. Three of them had US guided drainage of an intra abdominal collection of bile, three patients with bile leaks had ERCP Sphincterotomy and stent insertion alone and six patients with partially occluded CHD with bile leak had an ERCP performed with Sphincterotomy, balloon dilatation of the stricture followed by stentinsertion. Seventeen patients underwent elective surgical repair of their bile duct injuries, in this group patients had Roux -en Y hepaticojejunostomy performed to 16 cases. One case was managed by choledechodoudenostomy. Short term results were generally satisfactory. The short term morbidity of the patients who underwent the operative procedures included. One patient developed a transient attack of cholangitis, which was controlled by antibiotics. One patient developed jejunal fistula and two patients developed restricture. There was one mortality case due to hepatorenal failure. The short -term morbidity of the patients who underwent the endoscopic procedures included one patient developed pancreatitis and another case developed cholangitis. They are treated conservatively. This study revealed the following findings and recommendations: ERCP has the advantage of being diagnostic and therapeutic modality as it can be used in detection of level of injury, stenting and dilatation of strictures. MRCP has excellent standard in determining the exact site of injury and in demonstrating of the exact anatomy of the proximal biliary tree. PTC is helpful in identifying the proximal extent of complete segmental and major bile duct injuries and obstruction. A Roux -en Y choledoco -or hepaticojejunostomy is the procedure of choice if the defect is more than 1 cm long or is detected a long time after the injury. Safe surgery during cholecystectomy should be the rule in practice.