Injury to the liver and biliary system occurs from both blunt and penetrating mechanisms. While relatively uncommon, when present, there can be significant morbidity and mortality associated with these injuries. In this chapter, we will review liver anatomy, classification of injury, presentation, and the management of liver and biliary trauma. A more conservative approach has developed over the last decade for the management of these injuries, including close observation, monitoring, and interventional radiology techniques. Intervention, including operative management, is dependent on individual patient factors including hemodynamic stability and the severity of injury. We will focus on operative technique for the management of these complex injuries and discuss the potential complications from the many different management options.