Objective: To investigate the surgical technique and measures for prevention of postoperative pancreatic fistula in dealing with intrapancreatic choledochal cyst in adults. Methods: The clinical data of 41 patients with intrapancreatic choledochal cyst admitted from January 2006 to December 2013 were reviewed. The surgical method and technique as well as the causes for pancreatic fistula were analyzed. Results: With complete exposure of the intrapancreatic choledochal cyst after isolation of the head of the pancreas and the second and third portion of the duodenum through Kocher’s incision, 38 patients underwent cyst excision or treatment by mucosal stripping or cauterization of the cyst, and 3 patients were subjected to pancreaticoduodenectomy. All patients were discharged from hospital after recovery and no surgical death occurred. Portal vein injury occurred in one patient (2.4%) during surgery, and bile leakage occurred in one patient (2.4%), pancreatic fistula occurred in 4 patients (9.8%) following continuous suture of the bile duct stump and wound infection occurred in 5 patients (12.2%) after surgery. During follow-up for 6 months to 8 years, fever and chills occurred in 3 cases within 3 months postoperatively, one case died of tumor recurrence and two cases died of cerebral hemorrhage, while no postoperative abdominal pain, fever or recurrence of jaundice was noted in any of the other patients. The postoperative pathology revealed that in the 41 cases of intrapancreatic choledochal cyst, one case was complicated with myxopapilloma, 3 cases with mucinous adenocarcinoma, and 2 cases with adenocarcinoma. Conclusion: The procedure for intrapancreatic choledochal cyst is relatively complicated, so cyst excision or treatment by mucosal stripping or cauterization should be properly selected under the condition of adequate isolation of the head of the pancreas and the second and third portion of the duodenum. Appropriate closure of the common bile duct stump and avoidance of injury of the pancreatic duct are effective measures for prevention of pancreatic fistula.