Minimally invasive treatment of Mirizzi’s syndrome: is there a safe way? Report of a case series

Piccinni, Giuseppe; Sciusco, Andrea; Luca, Giuseppe Massimiliano De; Gurrado, Angela; Pasculli, Alessandro; Testini, Mario

doi:10.1016/s1665-2681(19)31257-8

Cited by 20 publications

(25 citation statements)

References 27 publications

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“…In our experience laparoscopy is no longer a contraindication for the treatment of Mirizzi syndromes with a cholecystobiliary fistula. It is not strictly necessary to obtain a "critical view" of Calot's triangle or perform a choledochotomy for exploring the CBD [5,10,18,19,24], avoiding hazardous dissection and further biliary tract injuries. There were no conversions to open surgery in our series.…”

Section: Discussionmentioning

confidence: 99%

“…McSherry proposed a classification of Mirizzi syndrome into two types based on ERCP findings. Type I is characterized by the extrinsic compression of the common hepatic or proximal common bile duct (CBD) due to an impacted gallstone in the infundibulum or cystic duct with subsequent inflammation, whereas type II is associated with a cholecystocholedochal fistula [4,10]. Csendes' classification further divides cholecystobiliary communication into three types according to the size of the cholecystocholedochal fistula in relation to the circumference of the CBD [1].…”

mentioning

confidence: 99%

“…Pre-operative diagnosis of this condition is challenging, as there are no pathognomonic signs or symptoms. Obstructive jaundice and abdominal pain are the most frequent symptoms found in these patients [4,10]. Diagnostic sensitivity of imaging tests is variable, ranging between 13% for ultrasound (US), 31% for computed tomography (CT), 76% for magnetic resonance cholangiopancreatography (MRCP), and 58% for endoscopic retrograde cholangiopancreatography (ERCP) [13].…”

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confidence: 99%

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Laparoscopic management of type II Mirizzi syndrome

et al. 2020

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Background Mirizzi syndrome is an uncommon complication of longstanding gallstone disease. Pre-operative diagnosis is challenging, and to date, there is no consensus on the standard management for this condition. Until recently open cholecystectomy was the standard of care for type II Mirizzi syndrome (McSherry classification). The objective of this study was to assess the incidence and management of type II Mirizzi syndrome in patients with proven or suspected choledocholithiasis undergoing laparoscopic common bile duct (CBD) exploration and present our experience in the laparoscopic management of this rare condition over the last 21 years. Methods Prospective data collection of eleven cases of type II Mirizzi syndrome amongst a series of 425 laparoscopic bile duct explorations was performed between 1998 and 2019. Demographic, clinical, diagnostic, intra-operative, and postoperative data were recorded. Results The incidence of type II Mirizzi syndrome was 2.6% in 425 laparoscopic CBD explorations. All operations were completed laparoscopically with closure of the defect over a decompressed CBD (T-tube n = 3, antegrade stent n = 5, transcystic drain n = 2), and in one case a non-drained duct was closed with Endoloop. Stone clearance rate was 100% (11 cases). In two patients the transinfundibular approach was used in conjunction with holmium laser lithotripsy to enable choledochoscopy and successful stone clearance. Three patients were complicated in the post-operative period with bile leak (n = 2) and lower respiratory tract infection (n = 1). An incidental gallbladder carcinoma was found in one patient. Conclusion Laparoscopic management of type II Mirizzi syndrome is feasible and safe when performed by experienced laparoscopic foregut surgeons. Laparoscopy and choledochoscopy can be combined with novel approaches and techniques to increase the likelihood of treatment success.

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Section: Discussionmentioning

confidence: 99%

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Laparoscopic management of type II Mirizzi syndrome

et al. 2020

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“…There are only few reports on the diagnosis of biliary fistulas by EUS, but it has been suggested that intraductal ultrasonography (IDUS) has a high sensitivity (97%) and specificity (100%) in all types of Mirizzi's Syndrome [ 26 – 28 ]. ERCP has a diagnostic accuracy of the primary biliary fistulas ranging from 55% to 90% and it has also a therapeutic-operative role: retrieval of the stones after sphincterotomy and placement of stents and a nasobiliary drainage of the biliary tree are useful for the best treatment of the patients [ 29 , 30 ].…”

Section: Diagnosismentioning

confidence: 99%

Diagnosis and Treatment of Biliary Fistulas in the Laparoscopic Era

Crespi

Montecamozzo

Foschi

2016

Gastroenterology Research and Practice

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Biliary fistulas are rare complications of gallstone. They can affect either the biliary or the gastrointestinal tract and are usually classified as primary or secondary. The primary fistulas are related to the biliary lithiasis, while the secondary ones are related to surgical complications. Laparoscopic surgery is a therapeutic option for the treatment of primary biliary fistulas. However, it could be the first responsible for the development of secondary biliary fistulas. An accurate preoperative diagnosis together with an experienced surgeon on the hepatobiliary surgery is necessary to deal with biliary fistulas. Cholecystectomy with a choledocoplasty is the most frequent treatment of primary fistulas, whereas the bile duct drainage or the endoscopic stenting is the best choice in case of minor iatrogenic bile duct injuries. Roux-en-Y hepaticojejunostomy is the extreme therapeutic option for both conditions. The sepsis, the level of the bile duct damage, and the involvement of the gastrointestinal tract increase the complexity of the operation and affect early and late results.

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“…Также были определены и необходимые составляющие синдрома. К ним относят взаимную направленность пузырного протока (ПП) и ОПП, фиксацию конкремента в шейке желчного пузыря либо в ПП, обструк цию ОПП конкрементом либо инфильтративным процессом, ремиттирующую желтуху, создающую фоновые условия для развития повторного холангита и (или) билиарного цирроза печени [2,[8][9][10][11].…”

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Mirizzi Syndrome – a Variable Course with Double Block of Bile Flow

Nazyrov¹,

Devyatov²,

Salimov³

2016

Ann. hir. gepatol.

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Частота синдрома Мириззи (СМ) у пациентов, подвергнутых холецистэктомии, составляет 0,06-5,7% [1-3]. Являясь осложнением желчнокаменной болезни, СМ нередко представляет собой сложную проблему на всех этапах диагностики и хирургического лечения [4-7]. При развитии этого осложнения высок риск формирования стриктуры желчных протоков, фистул и би-лиарного сепсиса, в том числе ятрогенного характера [3]. В последние годы отмечен рост частоты СМ. По мнению ряда авторов, это связано как с увеличением заболеваемости желчнокаменной болезнью, так и с уменьшением хирургической активности при острых формах калькулезного холецистита [5]. Необходимо также отметить факт так называемой искусственной

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Minimally invasive treatment of Mirizzi’s syndrome: is there a safe way? Report of a case series

Cited by 20 publications

References 27 publications

Laparoscopic management of type II Mirizzi syndrome

Laparoscopic management of type II Mirizzi syndrome

Diagnosis and Treatment of Biliary Fistulas in the Laparoscopic Era

Mirizzi Syndrome – a Variable Course with Double Block of Bile Flow

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