Laparoscopic cholecystectomy has quickly become the gold standard for the treatment of symptomatic cholelithiasis. With the introduction of this new technique has come a learning curve, with a higher than expected initial rate of complications. The most significant complication, as with open cholecystectomy, is injury to the bile duct. This article reviews the clinical features and mechanisms of major biliary injury in laparoscopic cholecystectomy. © 1993 W.B. Saunders Company. All rights reserved.