Laparoscopic biliary tract resection and reconstruction is not currently widely applied because it is technically challenging even in an open setting. In addition, there are alternatives to surgery such as endoscopic placement of biliary stents or percutaneous placements of transhepatic biliary drains for biliary obstruction. Nonetheless, laparoscopic cholecystojejunostomy, choledochoduodenostomy, hepaticojejunostomy, and choledochal cyst excision have been successfully performed in the hands of experienced laparoscopic surgeons.22–27 Surgical biliary bypass to relieve malignant obstructive jaundice requires the morbidity of an operation whether it is minimally invasive or open. While minimally invasive surgery allows for less postoperative pain and more expedient recovery, the inherent risks of general anesthesia and surgical stress remain. In light of this, endoscopic stenting has gained utility especially in the palliative setting. The success of endoscopic techniques, such as stenting and sphincterotomy, in the management of malignant biliary obstruction is well documented.28 However, recurrent jaundice and cholangitis from stent obstruction or migration necessitate changing of the stents and add to the overall morbidity and cost. Newer, self-expanding metallic wall stents have had less frequent rates of occlusion.29 Nonetheless, patients who are younger, healthier, who might have increased survival (>6 months) or for those whom endoscopic biliary stenting is not technically possible, will be better served by a surgical biliary bypass. For benign disease, endoscopic management is not indicated as it does not achieve the long-term patency that is desirable for the treatment of benign disease. Thus, surgical biliary bypass will continue to be a valid treatment option.