**7.2.1 Immediate repair of IBDI**

In the case of intraoperative recognition of bile duct injury, it is recommended that intraoperative cholangiography or conversion from laparoscopic cholecystectomy to open, allowing a better insight into the operative field and immediate repair. The injury should be repaired by an experienced hepatobiliary surgeon. If it is impossible, a patient should be transferred to a referral hepatobiliary surgery center, after adequate drainage of a subhepatic region. If the cut bile duct is less than 2-3 mm in diameter, without communication with the main biliary system, it should be ligated in order to avoid postoperative bile leak leading to development of the biloma and abscess in the subhepatic region. Bile ducts with a diameter of 3-4 mm or more should be surgically repaired because they drain the larger area of the liver. Interruption of CHD or CBD continuity can be repaired by immediate tension-free end-to-end ductal anastomosis with or without a T tube, using absorbable sutures. Security of the immediately repaired bile duct with a T tube is controversial. If the bile duct loss is too long and immediate end-to-end biliary anastomosis is not possible without tension, hepaticojejunostomy Roux-Y is recommended.
