COMPLETE EXCISION OF THE INTRAPANCREATIC PORTION OF CHOLEDOCHAL CYSTS

BACKGROUND: Cyst excision is the treatment for patients with choledoch al cysts. In general, many authors recommend intramural dissection bet ween the outer and inner layers of the cyst or partial excision leavin g 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 cys t should be resected and what resection technique should be used. STUD Y DESIGN: During an 18-year period, 104 patients underwent excision of choledochal cysts at our hospitals. Twelve patients had partial excis ion of the cyst above the pancreas, and 17 had intramural dissection o f the intrapancreatic portion. Seventy-five patients underwent complet e excision of the intrapancreatic portion of the cyst by our new techn ique, in which the outer plane of the epicholedochal plexus is dissect ed, exposing the narrow distal segment connecting the cyst to the panc reatic duct. Our new technique was compared retrospectively with the o ther two techniques. RESULTS: With our technique, the intrapancreatic cyst could be excised completely in 75 patients without any complicati ons. Blood loss was significantly decreased when our technique was use d compared to intramural excision. A pancreatic fistula occurred after intramural excision in one patient, and pancreatic stones formed seve ral years after partial excision and intramural excision in three pati ents who proved to have residual cystic material in the pancreas. CONC LUSIONS: Our operative technique is safe and effective for the complet e excision of the intrapancreatic portion of a choledochal cyst.