【 Abstract 】 Objective To investigate the cause, management and prevention of biliary fistula with un-typical after laparoscopic cholecystectomy (LC). Methods Twenty-one cases of biliary fistula with un-typical after LC were reviewed retrospectively. Results All patients displayed with un-typical expression and had no obvious signs of peritonitis. Lump of right upper quadrant (6 cases) ， vague pain of epigastric zone (11 cases) ， abdominal distention (3 cases) and bowel obstruction (1 case) after operation were main manifestations. Abdominal paracentesis (14 cases) ， bile exuded from incisional opening of trocar (6 cases) and exploratory laparotomy (1 caes) were the methods of final diagnosis. The cause of biliary fistula included cystic stump fistula (2 cases) ， aberrant bile-duct fistula (9 cases) ， and accessory hepatic duct fistula (4 cases). Laparoscopic approach and puncturation and drainage under ultrasound were the main therapeutic methods. All patiens were discharged successfully with no death case. Nineteen cases were followed up for 3 months to 2 years, and all patients recovered very well. Conclusion The biliary fistula with un-typical after LC is scarce ， and it can lead to missed diagnosis and treatment. Strengthening recognition of biliary fistula after LC ， and paying attention to chief complaint and abdominal sign can help discover biliary fistula early. Laparoscopic approach and puncturation under ultrasound are the recommended therapeutic methods.