Effect of Common Bile Duct Opening Versus Ligation on Postoperative Outcomes in Patients Undergoing Pancreaticoduodenectomy

Background Complications after pancreaticoduodenectomy are common and may be life-threatening. Management of the common bile duct stump may affect biliary pressure, drainage, and postoperative outcomes. This study seeks to compare open versus ligated bile duct stump management during pancreaticoduodenectomy.Methods This retrospective cohort included 125 patients who underwent pancreaticoduodenectomy between 2019 and 2025. Surgical outcomes and postoperative recovery were compared between the open-stump and ligation groups. Multivariable logistic regression identified associations between stump management and postoperative complications; biochemical indicators were also assessed.Results After adjustment, the opening group had significantly lower risks of pancreatic fistula (aOR = 0.18, 95%CI: 0.05 − 0.68, P = 0.011) and intra-abdominal and gastrointestinal bleeding (aOR = 0.09, 95%CI: 0.01 − 0.77, P = 0.028) versus the ligation group. The opening group also demonstrated a shorter surgical duration (315 minutes vs. 420 minutes, P < 0.001), reduced postoperative hospitalization (24 days vs. 30 days, P = 0.002), and lower costs (109,375 RMB vs. 137,518 RMB, P < 0.001). No significant changes were seen in liver function or coagulation markers.Conclusion Keeping the common bile duct open markedly enhances perioperative management during pancreaticoduodenectomy, thus serving as a significant reference for refining surgical protocols.