Pre-Operative Ercp Bile Duct Stenting and Laparoscopic Choledochoplasty Is Safe and Effective in the Management of Mirizzi’s Syndrome

Abstract

BACKGROUND Mirizzi's syndrome is a rare condition caused by the obstruction of the common bile duct or common hepatic duct by external compression from multiple impacted gallstones or a single large impacted gallstone in Hartman's pouch. Presenting symptoms are similar to cholecystitis but may be confused with other obstructing conditions such as common bile duct stones and ascending cholangitis due to presence of jaundice. Preoperative diagnosis is often difficult and usually missed. We wanted to analyse the clinical presentation, pre-operative diagnostic strategies, pre-operative bile duct stenting with ERCP, operative management and outcome of patients operated for Mirizzi's syndrome in a tertiary care center. METHODS This is retrospective study. Patients operated for Mirizzi's syndrome between May 2015 and August 2018 were included in the study. Their pre-operative demographics, pre-operative diagnostic strategies, operative management and outcome were recorded and analysed. RESULTS A total of 6 patients was identified out of 350 laparoscopic cholecystectomies performed during study period giving an incidence of 1.7 %. There were 5 males and 1 female with a mean age of 50 years. abdominal pain and jaundice were predominant symptoms and altered liver function tests were seen in all patients. Magnetic resonance cholangiopancreatography (MRCP) was the main stay of diagnosis and diagnostic of Mirizzi's syndrome in all patients. All patients in this study were having type III Mirizzi's syndrome. Pre-operative endoscopic retrograde cholangiopancreatography (ERCP), bile duct stenting, and laparoscopic choledochoplasty sufficed in all patients and none required Hepaticojejunostomy. CONCLUSIONS Mirizzi's syndrome a rare complication of cholelithiasis is a formidable diagnostic and therapeutic challenge. Pre-operative Magnetic Resonance Cholangiopancreatography (MRCP) is the main diagnostic strategy. Preoperative Endoscopic Retrograde Cholangiopancreatography (ERCP), bile duct stenting enable the surgeon to identify and minimize duct injury, and laparoscopic choledochoplasty is feasible and safe in most cases as well.