Purpose: The most common forms of bile duct injury (BDI) involve damage at the level of the common hepatic duct. Because it is so close, the right hepatic artery (RHA) may also be harmed. Reports on the frequency and significance of RHA injury (RHAI) associated with BDI are sparse. What is available suggests that the combination substantially decreases the success of the bile duct repair and increases the mortality rate. In this large series we examined the incidence, mechanism, and consequences of RHAI accompanying major BDI from laparoscopic cholecystectomy. Methods: 246 cases of laparoscopic BDI were referred for evaluation. The status of the RHA was discernable in 213 cases, which constituted the study group. Based on anatomic pattern, the BDI were: Class I, 8%; Class II, 26%; Class III, 55%; and Class IV, 11%. There were 168 women and 45 men, whose average age was 46 years. Complications associated with RHAI were identified. Results: RHAI was present in 66 cases (31%). The association of RHAI by BDI Class was: Class I, 6%; Class II, 16%; Class III, 33% (P < 0.05 vs Class I or II, X²); and Class IV, 71% (P < 0.002 vs Class I, II or III, X²). RHAI had no influence on the success of the BDI repair or the mortality rate (see Table). RHAI was more commonly associated with abscess formation, intra-operative bleeding, post-op bleeding, hemobilia, right hepatic lobe ischemia, and subsequent need for hepatectomy (see Table). Overall, 61% of patients with RHAI, compared with 11% of patients without RHAI, suffered one or more of these complications (P < 0.0001, X²). Excluding intra-op bleeding, 40% of patients with RHAI, compared with 3% of those without RHAI, had one or more of these complications (P < 0.0001, X²). Conclusions: RHAI occurred more often with Class III and IV BDI, but less often with Class II BDI, which reflects differences in the mode of injury between these categories. RHAI did not increase the mortality rate or decrease the success of the biliary repair. Nevertheless, RHAI was more often (40%) followed by abscess formation, bleeding, hemobilia, hepatic ischemia, and the need for hepatic resection. This is the first large series that clearly delineates these important relationships.