Both open cholecystectomy and laparoscopic cholecystectomy are highly safe and effective procedures for the treatment of patients with symptomatic cholelithiasis. Today, adverse outcomes after open cholecystectomy are largely limited to elderly patients with co-morbid conditions and complicated biliary tract disease. Although infrequent, major biliary complications still occur and have been slightly more common in the initial experience with laparoscopic cholecystectomy. Diagnosis of these potentially serious problems is founded on recognition of their early clinical manifestations and accurate cholangiographic definition on which definitive therapy is predicated.