In case of choledochal cyst, side-to-side choledochoduodenostomy is NOT recommended because of the risk of:
The treatment for choledochal cyst is complete excision with Roux-en-Y hepaticojejunostomy. The duodenal end of the bile duct should be oversewn without injury to the anomalous entry of the pancreatic duct, limiting the amount of residual biliary tissue at risk for malignancy. Side-to-side choledochoduodenostomy is not recommended because it is followed by a high incidence of stricture of the anastomosis and recurrent cholangitis. Cholecystectomy is always performed. Ref: Albanese C.T., Sylvester K.G. (2010). Chapter 43. Pediatric Surgery. In G.M. Dohey (Ed), CURRENT Diagnosis & Treatment: Surgery, 13e.
Malignancy
Pancreatitis
Recurrent Cholangitis
Gall stones