Causes and counter measures of reoperation for biliary diseases / 中华消化外科杂志

ABSTRACT

The reoperation for biliary diseases is usually unplanned, and the major reasons leading to this situation include(1) The initial operation was performed under emergency situation and radical procedure could not be carried out.(2) The surgical procedure was inadequate.( 3 ) The operator was unqualified for the operation. In order to avoid repeated operations,the following principles must be obeyed strictly.Firstly,once the initial operation was failed,the patients must be transferred to large medical center and the reoperation must be performed by hepatobiliary specialists.Secondly,the operator must realize that most of the patients were in poor condition because of the previous operation,and they needed careful evaluation of organ function and adequate supportive treatment before reoperation.Thirdly,various measures must be taken to avoid unplanned operation and ensure the successful implement of radical operation at a time( 1 ) Operator must learn all the details of previous operation,which include operation procedure,findings during operation and postoperative complications.( 2 ) Cholangiogram of the whole biliary tree is important for surgical planning,ultrasonography,computed tomography (CT),endoscopic retrograde cholangiopancreatography,magnetic resonance cholangiopancreatography, percutaneous transhepatic cholangiography (PTC),or PTC-CT should be performed solely or comprehensively to determine the nature and location of lesions.For bile duct injury,additional examination including CT angiography,magnetic resonance angiography or digital subtraction angiography is necessary to ascertain the accompanied vessel injury.(3) Making individual surgical procedure according to patien's condition and distribution of lesions.