Background: Bile duct injury (BDI) has been considered as one of the main complications in the context of biliary surgery which include laparoscopic cholecystectomy (LC). The treatment of major BDI is a surgical challenge even for skillful surgeons. Aim: To evaluate different therapeutic modalities of bile duct injuries and which was better according to type and time of injury (early or late presentation) outcome and improvement of quality of life (QoL). Methods: This was non randomized clinical trial study (prospective study), was conducted on thirty cases at the Faculty of Medicine, Aswan & Assuit Universities, Egypt during a period of 4 years. Results: The complications were significantly reduced in endoscopic group in comparison with surgical and radiological groups (p = 0.002). in our study 76.6 % of the patients has obesity which represent significant positive relationship to incidence of bile duct injury due to difficult surgery and dissection during cholecystectomy, excess fatty tissue can obscure important structure and leads to misidentification. Conclusion: Endoscopic management is comparatively simple, reversible, and minimally invasive. On the other hand, the success of endoscopic approach is mainly reliant on the type of injury. Endoscopy is comparable to surgery during the initial management of minor problems, however in terms of major leaking, ligation, transection, and complicated problems, surgery is the primary therapeutic modality because of its invasiveness.