Introduction: Major bile duct injury following cholecystectomy is a serious complication having a considerable long-term morbidity and occasional mortality. This is aggravated by delayed recognition of injury or a failed initial repair. Major bile duct injury can occur due to open or laparoscopic cholecystectomy. The aim of this analysis was to identify the possible differences between major bile duct injury associated with open and laparoscopic cholecystectomy. Method: This retrospective review includes 16 consecutive major bile duct injuries following cholecystectomy, undergoing management in a single unit at our hospital, which is a tertiary care referral centre between March 2004 and April 2008. Major bile duct injury was defined as occlusion of the common bile duct either by transection or development of a stricture or major segmental ducts injured at the porta hepatic. The patient profile, time of presentation, and primary management were recorded. Results: There were 14 female (87.5 %) and two male (12.5 %) with a mean age of 44.1 ± 16.4 years. Thirteen patients (81.2 %) were referred from outside our institute and one patient with history of prior repair. Nine patients (56.3 %) underwent open cholecystectomy and seven patients (43.7 %) underwent laparoscopic cholecystectomy. In one patient the laparoscopic cholecystectomy was performed due to acute cholecystitis in an emergency surgery. Four of the injuries (25.0 %) were recognized intra-operatively. This intra-operative diagnosis led to immediate conversion of the procedure to a standard laparotomy. The other twelve injuries (75.0 %) were diagnosed postoperatively and manifested as biliary peritonitis and emergency surgery (two patients -16.7 %), bile leakage (three patients - 25.0 %), or jaundice (seven patients - 58.3 %). The diagnosis was confirmed by abdominal ultrasound, computed tomography, magnetic resonance cholangiography or endoscopic retrograde cholangiograms. The Bismuth’s classification was Type I in 3 patients, Type II in 9 patients, Type III in 3 patients and Type IV in 1 patient. Surgical management in all patients consisted of Roux-en-Y hepaticojejunostomy. The anastomosis was carried out to the confluence, which was extended to the left duct. The mean postoperative length of stay was 11 days (range 5-42 days). There was one death (6.25 %). Conclusions: Major bile duct injuries remain a significant problem in biliary surgery. When the first repair is performed by surgeon experienced in hepatobiliary surgery, the success rate is high. There was no difference between laparoscopic and open cholecystectomy in terms of outcome and complications.