Extrahepatic bile duct resection and bile duct reconstruction is often required to manage major bile duct injuries and to restore biliary drainage. For tumors, isolated bile duct resections are uncommon. Most bile duct resections are commonly performed as components of multivisceral resections including pancreaticoduodenectomy or extended hepatectomies. Hepaticojejunostomy is the gold standard method for reconstruction, as it is associated with the best long-term outcomes. This chapter reviews the key surgical principles for bile duct resection and reconstruction.