Purpose Major bile duct injuries (BDI) are a serious complication of cholecystectomy. We describe a minimally invasive approach to a case of major BDI through primary laparoscopic repair combined with endoscopic and interventional radiologic techniques. Methods We discuss the case of an 81-year-old lady who sustained a Strasberg E2 injury during an elective laparoscopic cholecystectomy. The intra-operative cholangiogram confirmed a bile leak from the right posterior hepatic duct at 1cm from the biliary hilum. The ductotomy was immediately repaired with 4-0 polydioxanone sutures. Post-operatively, she first underwent an ERCP with a plastic stent placement in the common bile duct. She then had a PTC, during which a balloon cholangioplasty of the duodenal papilla was performed, and a biliary stent was deployed across the defect from the right hepatic duct into the duodenum, coupled with a PTBD into the right hepatic duct. A progress PTC at 6 weeks showed no bile leak, and a repeat ERCP 4 weeks later demonstrated no stricture at the previous injury site. Following the discussion of this case, a literature review was also performed. Results The management of major BDI commonly involves major biliary reconstructive surgery, such as a Roux-en-Y hepaticojejunostomy. Despite increasing adoption of endoscopic and interventional radiologic approaches to major BDI, there remains limited data on their long-term patient outcome. Conclusion This case provides new insights into the feasibility of endoscopic and interventional radiologic techniques as a less invasive alternative in managing Strasberg E2 BDI. It also underscores the need for further large-cohort research into its associated long-term outcome to help optimise patient selection.