Is it necessary to ligate distal common bile duct stumps after excising choledochal cysts?

PURPOSE: After excision of choledochal cysts (CDC), the distal common bile duct (CBD) stumps are conventionally ligated. Yet, the distal common bile duct stump mobilization and ligation carries certain risk of pancreatic duct injury. The current study investigates the feasibility of selectively leaving distal stump unligated in CDC children with stenotic distal CBD.

METHODS: Between 2001 and 2010, 270 CDC children successfully underwent laparoscopic cyst excision and Roux-en-Y hepatojejunostomy and were recruited into this study. The distal stump management was based on its radiological morphology. The patients were divided into two groups: (1) non-ligation group (n = 207), where the distal stump was stenotic and was left unligated; (2) ligation group (n = 63), where the distal stump was not stenotic and was ligated. The pancreatic juice leakage rates were compared.

RESULTS: The median follow-up periods in the non-ligation and ligation group were 36 and 33 months, respectively. There was no pancreatic juice leakage in either group.

CONCLUSION: Not ligating distal stump is a feasible approach for managing CDC with stenotic distal CBD. It simplifies the operative procedure and may minimize pancreatic duct injury.