Studies on reoperations of extrahepatic biliary tree

Cholelithiasis is one of the most common health disorders, but biliary surgery is burdened with numerous specific complications. These reoperations may be divided into early and late reoperations in terms of their precise therapeutic and prognostic differentiation. Recently, residual stones have been successfully treated by endoscopic sphincterotomy and percutaneous or trans-T-tube tract choledochoscopy, and reoperation is not frequently required. The purpose of this study was to identify the most common complications of biliary surgery which require reoperation so as to establish the predisposing factors and suggest alternative strategies. Thus a retrospective review of biliary surgery at the Medical University of Varna, Bulgaria was performed to identify those cases which required reoperation for complications of biliary surgery and the specific complications which required additional surgery. Of 2874 biliary operations for benign conditions, 87 reoperations were performed: 34 due to early complications and 53 due to late complications. Forty-nine of the 87 patients had undergone the initial surgery in our hospital, while 38 had been in different hospitals. Residual stones were the cause for reoperation in 37 patients. Other causes were: stenosing papillitis: 22 (with or without stones and cholangitis); iatrogenic injuries (5); strictures (5); pancreatitis (7); fistulae, abscesses, and bleeding. The most commonly performed procedure during reoperation was biliodigestive anastomosis (36), followed by T-tube drainage (28), papillosphincteroplasty (4), and double drainage (PSP + BDA), which was performed in 4 patients. In order to avoid reoperation after biliary surgery, exact preoperative diagnosis (by ERCP or US), intraoperative cholangiography and choledochoscopy and accurate operative technique are of great importance.