Laparoscopic Treatment оf Mirizzi Syndrome

Background. Mirizzi syndrome (MS) is a relatively rare complication of cholelithiasis, which occurs in a wide range from 0.2 to 5% according to different authors. Today, the surgical treatment of MS remains a challenge.Aim of study. To determine the possibilities of laparoscopic interventions in the surgical correction of various types of MS.Material AND methods. The work is based on a prospective analysis of cases of laparoscopic treatment of 19 patients with MS who were treated in the emergency surgery departments of the Republican Scientific Center for Emergency Medical Care in 2017–2019. This is 22.9% of all admitted patients (83) with MS during this period. Type 1 MS was diagnosed in 3 patients (15.7%), type 2 was diagnosed in 16 patients (84.2%).Results. In all cases of type 1 MS, laparoscopic cholecystectomy was performed. A new method for the correction of type 2 MS by forming a sleeve from the gallbladder wall was suggested, which was performed in 10 patients with good results. In the postoperative period, no nonspecific complications were observed in patients undergoing laparoscopic interventions. One patient had residual choledocholithiasis, which was managed by day 5 after the surgery with endoscopic retrograde cholangiopancreatography and endoscopic papillosphincterotomy and the removal of the calculus from the common bile duct. The average duration of stay of patients in a hospital bed was 10.8 days. Fatal outcome was observed in 1 case (5.3%).Conclusion. 1. The inclusion of endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography and magnetic resonance imaging cholangiography in the diagnostic scheme improves the accuracy and quality of recognition of Mirizzi syndrome and allows the indications for the use of video laparoscopy to be evaluated. 2. Indication for laparocopic treatment of type 2 Mirizzi syndrome is the presence of a single calculus in the supraduodenal part of the common bile duct, which makes it possible to reduce the number of conversion to laparotomy. 3. In cases of type 1 Mirizzi syndrome, the operation of choice is laparoscopic cholecystectomy. 4. The operation of choice in patients with type 2 Mirizzi syndrome is laparoscopic subtotal cholecystectomy, fistula plasty with a gallbladder flap on the Kehr’s T-tube drain with the formation of a “cystic duct”-type sleeve.

Mirizzi Syndrome: An Experience in Laparoscopic Era

Objective:To assess the presentation and surgical management of Mirrizi syndrome patients who underwent LaparoscopicCholecystectomy. Study Design and Setting:Retrospective Descriptive Study was conducted at Surgical Department Combined MilitaryHospital Rawalpindi and Combined Military Hospital Quetta from 1st Jan 2010 to 20th Jan 2016. Methodology:Patients undergoing laparoscopic cholecystectomy during this period were retrospectively reviewed. Allcases of Mirizzi Syndrome (MS) were identified and data analysed. Results:A total of 5500 patients underwent laparoscopic cholecystectomy during this period. Approximately 26(0.47%)cases were identified to be having MS. Out of these 26 cases only 8 (30%) were males while 18 (70%) were females. Ageranged from 25 to 80 years. Three patients (11%) had an endoscopic retrograde cholangiopancreaticography (ERCP) done.Type-I MS was found in 19 cases (73 %), Type-II in 3 cases (11%), Type-III and Type-IV in 2 cases each (7.69 %).Conversion to open surgery was carried out in 15 cases (57.6 %). All type-I MS had cholecystectomy except one casewhere partial cholecystectomy was done. T-tube closure of common bile duct was done in all Type-II MS. Similarly T-tube closure was possible in two cases of type-III while one hadRoux-en-Y hepaticojejunostomy. All cases of type-IV MS had Roux-en-Y hepaticojejunostomy. One patient out of 26 (3.8 %) had carcinoma gallbladder. There was no mortality. Conclusion:Type-I MS can be managed with laparoscopic cholecystectomy in selected patients.Type-II and type-III MS may need placement of T-tube while most of type-IV MS are managed with Roux-en-Y hepaticojejunostomy.