Complete excision of the intrapancreatic portion of choledochal cysts

Cyst excision is the treatment for patients with choledochal cysts. In general, many authors recommend intramural dissection between the outer and inner layers of the cyst or partial excision leaving part of the cyst in the pancreas to avoid pancreatic injury. However, because there are few large series with long-term follow-up periods, it remains unclear how much of the intrapancreatic portion of the cyst should be resected and what resection technique should be used.

During an 18-year period, 104 patients underwent excision of choledochal cysts at our hospitals. Twelve patients had partial excision of the cyst above the pancreas, and 17 had intramural dissection of the intrapancreatic portion. Seventy-five patients underwent complete excision of the intrapancreatic portion of the cyst by our new technique, in which the outer plane of the epicholedochal plexus is dissected, exposing the narrow distal segment connecting the cyst to the pancreatic duct. Our new technique was compared retrospectively with the other two techniques.

With our technique, the intrapancreatic cyst could be excised completely in 75 patients without any complications. Blood loss was significantly decreased when our technique was used compared to intramural excision. A pancreatic fistula occurred after intramural excision in one patient, and pancreatic stones formed several years after partial excision and intramural excision in three patients who proved to have residual cystic material in the pancreas.

Our operative technique is safe and effective for the complete excision of the intrapancreatic portion of a choledochal cyst.