stated that results would only improve when the cyst was removed, the common bile-duct reconstructed, and the valvular mechanism of the bile-papilla thus retained.
It is generally considered to-day that choledochus cyst causes recurrent cholangitis and consequent liver damage, and should be treated by operation. Hertzler and Maguire (1951) recommend marsupialization of the cyst as a temporary measure in the acutely ill patient. They consider that anastomosis of the cyst wall to the duodenum (Gross, 1953;Ross and Carling, 1948) is liable to stasis and ascendmg cholangitis, and advocate excision of the cyst and direct anastomosis of the common hepatic or right and left hepatic ducts to the duodenum. Other methods of reconstruction after excision of the cyst include jejunal Row-en-Y anastomosis (Keeley, 1948), cholecysto-duodenostomy (Davis, 1948), and anastomosis of the retained upper pole of the cyst to the duodenum (McLaughlin, 1946). Gross states that excision of the cyst is entirely unnecessary and suggests direct anastomosis between cyst and duodenum with or without a relieving cholecystostomy. However, it seems reasonable to attempt to reduce the risks of cholangitis (theoretically) by using a Row-en-Y anastomosis as was done in two of our cases, and Maingot (1955) stresses that this operation, first performed by Priestley, should make a strong appeal to any surgeon encountering a choledochus cyst at exploration. Both our cases made an uneventful post-operative recovery, but the severe liver damage found in Case I makes eventual prognosis less hopeful.
SUMhWRY
Two cases of choledochus cyst are described, with a note on a third. All occurred in the same surgical unit within a period of three years. Investigations, diagnosis, and treatment are discussed.
Acknowledgements.-We wish to thank Mr. Alan Birt and Dr. Batty Shaw for permission to publish these cases, and for encouragement in presenting them for publication.