Reoperations upon the biliary duct system for benign disorders are still indicated

During the last 12 years, we performed 78 reoperations upon the biliary tract for benign disorders. Not included were early complications after the initial operation or endoscopic manipulation. The indications for reoperations were obstructive jaundice, recurrent colic and asymptomatic biliary fistula in 57, 18 and three patients, respectively. Endoscopic retrograde cholangiography was found to be the preoperative diagnostic method of choice. Intraoperative examination demonstrated cholangiolithiasis in 48 patients (five patients with stenosis), stenosis of the bile duct in eight, sump syndrome after choledochoduodenostomy in six and cholangitis without any further pathology in three. In three patients, the revision was negative. Several reinterventions were carried out: exploration of the bile ducts (12 per cent with papillotomy), removal of a biliodigestive anastomosis and a biliary enteric anastomosis in 52, 12 and 14 patients, respectively. The postoperative cholangiogram showed residual stones in 12 patients. Two-thirds of the stones disappeared spontaneously and one-third were removed endoscopically. There were local complications in 12 of the patients. The mortality rate was 6.4 per cent. All of these patients were more than 70 years old and were considered at high risk. In spite of endoscopic retrograde cholangiography, the number of operative reinterventions upon the biliary duct system has hardly declined over the last few years. This is partly due to new specific complications in connection with endoscopic retrograde endoscopy (perforation, hemorrhage or pancreatitis).