Biliary-intestinal anastomosis is a common surgical procedure for benign and malignant diseases in hepatobiliary surgery. Due to severe postoperative adhesions in the upper abdomen, especially in the porta hepatis, it can significantly increase the difficulty and risk of surgery during secondary surgery. So, in those cases biliary-intestinal anastomosis requires reoperation after surgery? 1, primary lesions not removed: intrahepatic bile duct stones not removed and missed diseases, such as intra- and extrahepatic bile duct cysts not detected in the first-stage surgery, or tumors of the lower bile duct, duodenum, jugular abdomen and head of the pancreas missed in the first-stage surgery, or not excised due to inadequate preparation. Biliary-intestinal anastomotic stenosis: Anastomotic stenosis is also one of the common reasons for reoperation after biliary-intestinal anastomosis. Anastomotic stenosis is often associated with the following factors: ① Poor anastomotic blood flow. In addition, excessive freeing of the bile duct wall may also lead to obstruction of the anastomotic blood supply. The anastomotic caliber is too small. Bile intestinal anastomosis, bile duct jejunostomy, and bile duct jejunostomy are too small when the bile duct wall is chronically inflamed and thickened, which can easily lead to circumferential narrowing of the anastomosis after surgery. ③Inappropriate anastomosis technique and material selection. Excessive anastomotic tension, uneven mucosal alignment, two-layer invagination suture and non-absorbable thick sutures can easily lead to anastomotic stenosis. ④Reflux cholangitis. Biliary-intestinal anastomosis, lateral biliary-intestinal anastomosis, and choledochoduodenal anastomosis can cause reflux cholangitis, resulting in inflammation and fibroplasia around the anastomosis, and finally leading to anastomotic stenosis. ⑤ Medical bile duct injury, especially electrothermal injury. If the biliary-intestinal anastomosis is done hastily before the injury level is determined, the postoperative injury level will continue to rise, leading to anastomotic stenosis. 3, surgical indications and improper selection of surgical methods: bile-intestinal anastomosis is mainly used to repair bile duct injuries and restore normal bile drainage channels. Improper choice of surgical method can cause blind loop syndrome, reflux cholangitis, anastomotic stenosis, bile duct cancer, stone regeneration and poor bile drainage. Due to the special and complex anatomical relationship of the porta hepatis, secondary surgery is bound to be very difficult, so the surgery should be handled carefully. Secondary surgery: 1.Pre-operative to be fully prepared: Pre-operative to improve the inspection to assess the overall condition of the patient such as liver function, adequate imaging inspection such as ultrasound, CT, MRCP, etc. to understand the lesion site and location relationship, so as to have a good idea of the initial strategy of the surgical approach. 2, intraoperative patience, careful: due to re-operation of serious abdominal adhesions, sometimes combined with serious biliary tract infection, so should be fully prepared for preoperative assessment and selection of a reasonable timing of surgery, the development of individualized surgical plan. The main points of attention during surgery are as follows: ① The incision should be adequately exposed, either by a right subcostal margin incision or a double subcostal margin roof-like incision with a longitudinal incision at the tip. ②The operation should be performed carefully and in a gradual manner. ③The hepatic hilum and the original biliary-intestinal anastomosis should be fully exposed. The hepatic hilum should be exposed closely to the liver lining from right to left and separated gradually from shallow to deep. The hilar bile duct can be exposed by lowering the hilar plate technique, square lobectomy or median hepatic splitting. The anastomosis can be revealed by finding the bile-intestinal loop first and then searching upward for the anastomosis, or by incising the bile-intestinal loop and exploring the anastomosis upward. The anastomosis can also be found from the lateral side of the descending duodenum upward gradually. For those who can easily reveal the hepatoportal bile duct, the anastomosis can be found from top to bottom. ④ According to the results of intraoperative exploration, combined with intraoperative cholangiography and cholangioscopic exploration, the reasons for reoperation can be clarified and a reasonable surgical approach can be selected.