SURGICAL REMOVAL OF PROTEIN PLUGS COMPLICATING CHOLEDOCHAL CYSTS - PRIMARY REPAIR AFTER ADEQUATE OPENING OF THE PANCREATIC DUCT

Background/Purpose: Recently, pancreaticoduodenectomies have been perf ormed for choledochal cysts complicated by protein plugs. The authors describe a new surgical procedure for removal of protein plugs or panc reatic stones that does not involve pancreatectomy, Methods: Protein p lugs were detected in 43 (34.1%) of 126 pediatric patients with choled ochal cysts. The plugs disappeared spontaneously in 26 patients and we re removed using nonsurgical methods in seven. The 10 patients treated surgically are considered here. Results: Protein plugs were removed w ith the residual cyst in one patient. The plugs in the common channel were flushed into the duodenum by irrigation with saline through the n arrow segment beneath choledochal cyst in another. The plugs were remo ved through the narrow segment using a blunt spoon in four. In the oth er four patients, the plugs that were too large or too hard to be remo ved through the narrow segment were taken away through an incision in the main pancreatic duct. This was followed by primary closure of the main pancreatic duct using the narrow segment as a flap to prevent str icture formation. All of the patients have done well. Conclusions: Pro tein plugs complicating choledochal cysts can be removed without pancr eatectomy. Particularly, primary repair of the pancreatic duct using a flap made of the narrow segment beneath the choledochal cyst is a saf e and feasible method to remove large or hard protein plugs. Copyright (C) 1998 by W.B. Saunders Company.