One-session laparoscopic management of Mirizzi syndrome: feasible and safe in specialist units

Abstract

Background To evaluate the laparoscopic management of Mirizzi syndrome, seldom diagnosed preoperatively causing difficulty when performing cholecystectomy and increasing complication risks. Methods Analysis of a prospective single-surgeon database of 5700 laparoscopic cholecystectomies found 58 Mirizzi syndrome cases. They were managed with an intention to treat during the index admission according to protocol of singlesession management of bile duct stones. Results 38/58 patients were females (65.5%). The median age was 55 years. 53 cases were emergency admissions. 34 cases (58.6%) only had ultrasound scanning. Operative difficulty was Grade IV in 34 cases (58.6%) and Grade V in 20 (34.5%) (Nassar Scale). There were 33 Mirizzi Type IA, 7 Type IB, 16 Type II and one each of Type III and Type IV. Bile duct exploration was performed in 94.8% through choledochotomy/ transfistula in 58.6% or transcystic in 36.2%. Four cases required conversion to open. Postoperative morbidity occurred in 29%. Two 30-day mortalities occurred from pneumonia in two elderly patients who were late referrals. Conclusion Although the utilization of the laparoscopic approach in managing bile duct stones is not currently widely practiced it was safer in this series than in reported series of open surgery in Mirizzi Syndrome. The optimal approach to Mirizzi Type II is via cholecystocholedochal fistula to explore the bile duct then drain with T-tube through the fistula. It is unnecessary to perform bilioenteric bypass in majority of cases, reducing the morbidity and mortality.

Achieving the critical view of safety in the difficult laparoscopic cholecystectomy: a prospective study of predictors of failure

“…The adoption of alternate dissection strategies and IOC in this study has resulted in the optimisation of important operative outcome parameters including less reliance on subtotal cholecystectomy and cholecystostomy, avoiding their potential adverse consequences. We also report safe laparoscopic completion of complex cases with Mirizzi Syndrome [31], cholecysto-duodenal and cholecysto-colic fistulae while avoiding open conversion and bile duct injuries.…”

Reinterventions following laparoscopic cholecystectomy and bile duct exploration. A review of prospective data from 5740 patients

“…The objective assessment of operative complexity facilitates audit, research, assessment of training and comparison between studies. The referral pathways and operative techniques have been described in detail in previous studies [5][6][7][8].…”

The Current Approach to the Diagnosis and Classification of Mirizzi Syndrome

“…In general, radiological investigations led to a presumptive diagnosis in seven cases (12%). All the remaining cases (n = 51, 87.9%) were discovered intraoperatively [10].…”

“…Based on data presented in articles, the overall frequency of MS was higher in females than in males. The proportion of females suffering from MS ranged between 55.6-77% [6][7][8][9][10]. However, the available data vary in different parts of the world.…”