Clinical Characteristics and Etiological Analysis of Postoperative Bile Leakage after Radical Resection of Choledochal Cyst

Background Congenital choledochal cyst (CCC) is a common biliary developmental anomaly in children, with Roux-en-Y anastomosis as the standard surgical procedure. However, the prevention and management of postoperative bile leakage remain clinical challenges, and its risk factors are not fully defined. Most existing studies are based on small samples or univariate analyses, lacking systematic evaluation. Objective To clarify the incidence, clinical characteristics, and potential risk factors of bile leakage after radical resection of CCC, to provide evidence-based references for optimizing surgical strategies and reducing postoperative complications. Methods A single-center retrospective cohort study was conducted, including 1853 patients who underwent radical resection of CCC at the Capital Institute of Pediatrics from January 2015 to January 2025. Bile leakage was diagnosed according to the criteria of the International Study Group of Liver Surgery (ISGLS), and cases were screened by 1:1 propensity score matching (PSM). Baseline, preoperative, intraoperative, postoperative, and imaging data were systematically collected, and statistical analyses were performed using R software 4.3.0. Results The incidence of postoperative bile leakage was 2.3% (42 cases), with anastomotic fistula accounting for 73.8%. The preoperative red cell distribution width to platelet count ratio (RPR) in the observation group (bile leakage due to anastomotic fistula) was significantly higher than that in the control group (P < 0.05). The incidence of proximal common bile duct adhesions in the observation group (90.3%) was significantly higher than that in the control group (58.1%, P < 0.05). Bile leakage mostly occurred 1–12 days postoperatively, and secondary surgery confirmed a high incidence of right anastomotic fistula (45.2%). After 2020, the incidence of bile leakage decreased from 2.8–1.1% (P < 0.05), but the proportion of bile leakage related to ectopic hepatic ducts increased. Conclusion Optimizing anastomotic techniques can reduce the incidence of bile leakage, and intraoperative exploration of ectopic hepatic ducts should be strengthened to prevent bile leakage.