Analysis Of The Causes Of Cholangioenterostomy Surgical Reoperation For Benign Biliary Disease

Objective By analyze the causes of reoperation after cholangioenterostomy,to sum up the experiences of prevention for cholangioenterostomy and provide the reference to reduce the reoperation ratio.Methods The clinical data of the patients were analyzed retrosepectively,who had experienced cholangioenterostomy reoperation for benign biliary disease in the last 8 years(from October 2009 to October 2017)at Ningxia Medical University General Hospital.Analysis the basic information of the patients before the first and the second operation: the age,the gender and the symptom;the information of the operation;the time interval between two surgeries,the reasons,the surgical anastomosis,the operation time,the intraoperative situation,the intraoperative blood loss;the postoperative curative effect.Results: We enrolled 24 patients who treated by choledochojejunostomy at least 2 times in that the biliary benign disease in this study.Among them,24 were undergone two times of choledochojejunostomy,4 were undergone three choledochojejunostomy operations,a case of four times choledochojejunostomy surgery history.Bile duct stone recurrence and / or residual is the main reason for the reoperation,we found 21 cases of stone(87.50%)in secondary operation.and found 18 cases of anastomotic stricture(75.00%),we also observed that choledocholithiasis in all of patients.3 cases(12.5%)of all were operated many times choledochojejunostomy by recurrent trouble of the refluxing cholangitis.and 8 cases who had improper operation at the first time.There is fewer the patients with at least three times of choleric anastomosis,however the leading causes are still stone,stenosis and reflux cholangitis.Conclusion Except the special physio-pathology of the biliary tract,the bile duct stone and anastomotic stricture is the reason for the cholangioenterostomy.Improper surgical methods and bile duct reflux and stones are also important causes of reoperation.Surgicalsutures should be made of synthetically absorbable sutures as much as possible to minimize inflammation and foreign body reactions.Anastomotic anastomosis should be as large as possible,if necessary,feasible bile duct plastic surgery,fusion,to prevent anastomotic stenosis.For the choice of surgical methods,due to the Warren anastomosis,the intestine ligature tends to loosen and aggravate the reflux.Roux-Y anastomosis is recommended.