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.