In our daily work, we often encounter patients who have undergone repeated surgeries or traumas on the same part of the body for various reasons, and the surgical treatment of these patients is sometimes very challenging clinically. After the previous surgery or trauma, the body tissues will form local scar and adhesions and lose the normal anatomical gap, especially the blood vessels, nerves and important organ pipelines adhere to each other and the surrounding tissues, which may deviate from the normal anatomical position, making it difficult to distinguish intraoperatively and even the possibility of injury, leading to serious postoperative complications. What is more difficult is that if the interval between two surgeries is short and the surgery is performed during the acute period of inflammatory reaction of the previous surgery, then the local tissues become more difficult due to the release of acute inflammatory inflammatory mediators, significant local congestion and edema, and more serious scar adhesions, resulting in unclear exposure of the operative field, disappearance of anatomical levels, increased brittleness of the vessel wall, bleeding tendency, and difficulty in hemostasis. The following is a case of a more difficult and complex secondary surgery. The patient, female, 61 years old, visited a county hospital in southwest China for “acute cholecystitis”, and the local hospital performed emergency surgical exploration and treatment. “Giant cystic occupancy in the head of the pancreas with involvement of the hepatic hilum”. As the patient failed in the first surgical exploration and was still in the postoperative acute inflammatory response period, the lesion involved the complex first hepatic hilar and pancreas, and the surgical risk was huge. However, the patient had progressively increasing pain in the right upper abdomen and presented with jaundice and fever, showing signs of acute biliary tract infection. The doctor happened to be in the southwest at that time, so he was invited by the local hospital to attend the consultation. After carefully reviewing the films and combining the relevant symptoms and signs, the doctor diagnosed that the patient was not a pancreatic head occupancy but a relatively rare congenital giant cyst of the common bile duct involving the left and right hepatic ducts of the first hepatic hilum, which had to be treated with immediate surgery because of poor bile drainage with acute biliary infection. The anatomy of the hepatic hilum is a difficult part of this type of surgery. The first hepatic hilum consists of the large vessels entering the liver, the hepatic artery and portal vein, and the common bile duct and associated lymph connective tissue that drain bile, and is often associated with congenital mutations of the vessels and bile ducts, making the exploration and surgery of the first hepatic hilum a more difficult procedure. Since the patient had already undergone an 8-hour-long surgery at an outside hospital to surgically explore the gallbladder and common bile duct, the local adhesions in the hilar region, as well as the acute inflammatory reaction, exacerbated the local anatomical ambiguity, and the slightest inadvertence could lead to damage to the vessels and bile ducts in the hilar region resulting in serious consequences. However, the patient’s condition could not be delayed, and failure to operate immediately might lead to acute septic obstructive cholangitis, resulting in toxic shock and even death. After repeated communication with the family and explanation of the risks, it was decided to perform an emergency exploratory surgery. Recurrent common bile duct cyst excision + high hilar cholangioplasty + common hepatic duct jejunal Roux-en-Y anastomosis + complex intestinal adhesion release was performed by the hospital. After careful preoperative film review and analysis: the huge common bile duct cyst severely compressed the portal portal vein and hepatic artery, while pushing the inferior vena cava, the largest vein in the human abdominal cavity. Due to the impact of the first surgery, if the dissection was performed from the traditional anterior approach, the surgery would be very traumatic, bleeding might be very high, and it would easily cause damage to the adjacent organs. Guided by the concept of precision hepatobiliary-pancreatic surgery, the operation was performed with a new approach, starting from the posterior side of the cyst, opening the lateral wall of the duodenum (Kocher incision), pushing the head of the pancreas and duodenum to the upper left, immediately in front of the inferior vena cava, gradually separating the adherent tissues, and carefully dissecting the huge cyst immediately behind the right side of the hepatoduodenal ligament, along the right side wall of the portal vein and The large cyst immediately adjacent to the portal vein and inferior vena cava was carefully separated. Although the adhesions were severe, the common surgical method of “open-cut-ligature” was not used, but only the ordinary electric knife was used to directly dissect the vessels and the adherent tissues in a more delicate layer, restoring the normal anatomical level. After restoring the normal anatomical level and vascular course, the cyst was finally successfully dissected from the large abdominal vessels. Further, in the hepatic hilum, 2 openings of the left and right hepatic ducts were shaped and stitched into a single opening, and a Roux-en-Y anastomosis was made with the jejunum. The patient recovered quickly after surgery, with the jaundice subsiding and liver function recovering, and was discharged 2 weeks later without any complications. The insight of this case is that for cases with severe local inflammatory tissue adhesions and edema and complex and confusing anatomical levels, it is necessary to be good at alternative and innovative changes in the conventional surgical approach based on precise surgical principles. In addition, sphincter dissection techniques for large vessels, solid skills in the use of the electric knife and fine dissection techniques for complex adhesions are also necessary to ensure successful surgery.