Primary excision of a choledochal cyst has recently become the operation of choice. A choledochal cyst is usually dissected in its wall. This commonly used approach could carry the risk of leaving the intrapancreatic portion of a choledochal cyst (IPCC) and of a considerable amount of hemorrhage. Complete excision of the IPCC is strongly recommended in order to avoid the stasis of pancreatic juice, the formation of caliculi, and the development of carcinoma of the IPCC. The operation technique for complete excision of the IPCC for choledochal cyst patients was described in detail; Bile duct arterial branch of the posterior superior pancreaticoduodenal artery was ligated and divided at first. The IPCC was dissected from the pancreas on the outer layer of the epicholedochal plexus in the cystic wall. The IPCC including a narrow segment beneath the cyst was resected. The cyst was lifted upward to expose the portal vein in the hepatoduodenal ligament and dissected up to the hepatic hilum. Between 1982 and 1985 January complete excision of the IPCC was performed in 11 patients with satisfactory results; 4 males and 7 females, whose age range from 4 month to 13 year old. No injury of the vascular, pancreatic and biliary ductal structures was encountered. Average blood loss was 133 g.
