Background: Bile duct injury (BDI) is a major complication in biliary surgery. The management of major BDI is a surgical challenge. Aim: evaluate different therapeutic modalities of bile duct injuries and which was better according to type and time of injury outcome and improvement of quality of life. Methods: This was a non-randomized clinical trial study was conducted on thirty cases at the Faculty of Medicine, Aswan & Assuit Universities, Egypt,from February 2018 till February 2022. All patients were grouped into either surgical, endoscopic and radiological groups. Results: 50.0% had endoscopic intervention, 33.3% had surgical intervention and 16.7% had radiological intervention. There was highly significant difference between studied groups as regards (mental health, physical score and body pain score), the quality-of-life scores were betters in radiological and endoscopic groups rather than surgical group. This study revealed that patients of bile duct injury managed by non-surgical way are satisfied and they can do well with less pain. Conclusion: Endoscopic management is relatively simple, minimally invasive. However, the success of endoscopic therapy depends on the type of injury. but for major leaks and complex problems, surgery is the aim.