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Wu J, Cai SY, Chen XL, Chen ZT, Shi SH. Mirizzi syndrome: Problems and strategies. Hepatobiliary Pancreat Dis Int 2024; 23:234-240. [PMID: 38326157 DOI: 10.1016/j.hbpd.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 01/26/2024] [Indexed: 02/09/2024]
Abstract
Mirizzi syndrome is a serious complication of gallstone disease. It is caused by the impacted stones in the gallbladder neck or cystic duct. One of the features of Mirizzi syndrome is severe inflammation or dense fibrosis at the Calot's triangle. In our clinical practice, bile duct, branches of right hepatic artery and right portal vein clinging to gallbladder infundibulum are often observed due to gallbladder infundibulum adhered to right hepatic hilum. The intraoperative damage of branches of right hepatic artery occurs more easily than that of bile duct, all of which are hidden pitfalls for surgeons. Magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) are the preferable tools for the diagnosis of Mirizzi syndrome. Anterograde cholecystectomy in Mirizzi syndrome is easy to damage branches of right hepatic artery and bile duct due to gallbladder infundibulum adhered to right hepatic hilum. Subtotal cholecystectomy is an easy, safe and definitive approach to Mirizzi syndrome. When combined with the application of ERCP, a laparoscopic management of Mirizzi syndrome by well-trained surgeons is feasible and safe. The objective of this review was to highlight its existing problems: (1) low preoperative diagnostic rate, (2) easy to damage bile duct and branches of right hepatic artery, and (3) high concomitant gallbladder carcinoma. Meanwhile, the review aimed to discuss the possible therapeutic strategies: (1) to enhance its preoperative recognition by imaging findings, and (2) to avoid potential pitfalls during surgery.
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Affiliation(s)
- Jun Wu
- Department of Hepatobiliary and Pancreatic Surgery, People's Hospital of Jiulongpo District, Chongqing 400050, China
| | - Shuang-Yong Cai
- Department of Hepatobiliary and Pancreatic Surgery, People's Hospital of Jiulongpo District, Chongqing 400050, China
| | - Xu-Liang Chen
- Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou 310003, China
| | - Zhi-Tao Chen
- Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou 310003, China
| | - Shao-Hua Shi
- Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou 310003, China.
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Touati MD, Belhadj A, Ben Othmane MR, Khefacha F, Khabthani S, Saidani A. Mirizzi syndrome: A case report emphasizing safe management strategies and literature review. Int J Surg Case Rep 2024; 116:109297. [PMID: 38325113 PMCID: PMC10859285 DOI: 10.1016/j.ijscr.2024.109297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 02/09/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Mirizzi syndrome, a rare complication of cholelithiasis, involves gallstones causing common hepatic duct compression. It poses diagnostic challenges with nonspecific symptoms. Early recognition and surgical intervention are crucial, emphasizing a multidisciplinary approach for this complex condition with potential complications. CASE REPORT A 69-year-old woman presented with pruritus, jaundice, and a history of hepatic colics. Laboratory results showed no signs of inflammation but indicated cholestasis. Imaging suggested Mirizzi syndrome type 1, confirmed by MRI. The patient underwent surgery, revealing Mirizzi syndrome type II with the presence of a cholecystocholedochal fistula involving less than one-third of the circumference of the main bile duct. Subtotal cholecystectomy and suturing of the main bile duct onto a T-tube were performed, resulting in a favorable recovery and normalization of blood tests after 10 days. CLINICAL DISCUSSION Mirizzi syndrome, named after surgeon Pablo Luis Mirizzi, was first detailed in 1948. Clinical symptoms include jaundice, colic pain, and complications such as cholecystocholedochal fistula and gallstone ileus. Blood tests and imaging aid diagnosis. Surgical management targets obstruction relief and defect repair. Dissecting Calot's triangle carries risks. In complex cases, cholecysto-choledocus-duodenostomy may be considered. CONCLUSION Mirizzi syndrome, a rare but significant condition, demands careful clinical attention to prevent underdiagnosis. Timely and appropriate management, utilizing imaging tests alongside ERCP, is essential for optimal outcomes and complication prevention.
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Affiliation(s)
- Med Dheker Touati
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628 Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Rue de la Faculté de Médecine, R534+F9H Tunis, Tunisia.
| | - Anis Belhadj
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628 Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Rue de la Faculté de Médecine, R534+F9H Tunis, Tunisia
| | - Mohamed Raouf Ben Othmane
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628 Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Rue de la Faculté de Médecine, R534+F9H Tunis, Tunisia
| | - Fahd Khefacha
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628 Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Rue de la Faculté de Médecine, R534+F9H Tunis, Tunisia
| | - Syrine Khabthani
- Faculty of Medicine of Tunis, University of Tunis El Manar, Rue de la Faculté de Médecine, R534+F9H Tunis, Tunisia; Anesthesia and Intensive Care Department, Mahmoud El Matri Hospital, V59M+628 Ariana, Tunisia
| | - Ahmed Saidani
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628 Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Rue de la Faculté de Médecine, R534+F9H Tunis, Tunisia
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Koo JGA, Tham HY, Toh EQ, Chia C, Thien A, Shelat VG. Mirizzi Syndrome-The Past, Present, and Future. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:12. [PMID: 38276046 PMCID: PMC10818783 DOI: 10.3390/medicina60010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/08/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024]
Abstract
Mirizzi syndrome is a complication of gallstone disease caused by an impacted gallstone in the infundibulum of the gallbladder or within the cystic duct, causing chronic inflammation and extrinsic compression of the common hepatic duct or common bile duct. Eventually, mucosal ulceration occurs and progresses to cholecystobiliary fistulation. Numerous systems exist to classify Mirizzi syndrome, with the Csendes classification widely adopted. It describes five types of Mirizzi syndrome according to the presence of a cholecystobiliary fistula and its corresponding severity, and whether a cholecystoenteric fistula is present. The clinical presentation of Mirizzi syndrome is non-specific, and patients typically have a longstanding history of gallstones. It commonly presents with obstructive jaundice, and can mimic gallbladder, biliary, or pancreatic malignancy. Achieving a preoperative diagnosis guides surgical planning and improves treatment outcomes. However, a significant proportion of cases of Mirizzi syndrome are diagnosed intraoperatively, and the presence of dense adhesions and distorted anatomy at Calot's triangle increases the risk of bile duct injury. Cholecystectomy remains the mainstay of treatment for Mirizzi syndrome, and laparoscopic cholecystectomy is increasingly becoming a viable option, especially for less severe stages of cholecystobiliary fistula. Subtotal cholecystectomy is feasible if total cholecystectomy cannot be performed safely. Additional procedures may be required, such as common bile duct exploration, choledochoplasty, and bilioenteric anastomosis. Conclusions: There is currently no consensus for the management of Mirizzi syndrome, as the management options depend on the extent of surgical pathology and availability of surgical expertise. Multidisciplinary collaboration is important to achieve diagnostic accuracy and guide treatment planning to ensure good clinical outcomes.
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Affiliation(s)
- Jonathan G. A. Koo
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore; (J.G.A.K.); (H.Y.T.)
| | - Hui Yu Tham
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore; (J.G.A.K.); (H.Y.T.)
| | - En Qi Toh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore;
| | - Christopher Chia
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, Singapore 308433, Singapore;
| | - Amy Thien
- Department of General Surgery, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan BA 1710, Brunei;
| | - Vishal G. Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore; (J.G.A.K.); (H.Y.T.)
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore;
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Karaahmet F, Kekilli M. Endoscopic retrograde cholangiopancreatography-oriented surgery for accomplished treatment of Mirizzi syndrome: a single-center experience. Eur J Gastroenterol Hepatol 2023; 35:537-540. [PMID: 36966768 DOI: 10.1097/meg.0000000000002534] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
BACKGROUND Mirizzi syndrome is a gallstone disease characterized by compression of extrahepatic biliary duct with an impacted stone. Our aim is to identify and describe the incidence, clinical presentation, operative details and the association postoperative complication of Mirizzi syndrome in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). METHODS The ERCP procedures were held in Gastroenterology Endoscopy Unit and retrospectively evaluated. The patients were divided into two groups, the cholelithiasis + common bile duct (CBD) stone group and the Mirizzi syndrome group. These groups were compared with the demographic characteristics, ERCP procedures, types of Mirizzi syndrome and surgical technique. RESULTS A total of 1018 consecutive patients who underwent ERCP were scanned retrospectively. Of the 515 patients fulfilling the criteria for ERCP, 12 had Mirizzi syndrome and 503 had cholelithiasis and CBD stones. Half of the Mirizzi syndrome patients were diagnosed with pre-ERCP ultrasonography. The mean diameter of choledoc was found to be 10 mm in ERCP. ERCP-related complication rates (pancreatitis, bleeding and perforation) were the same in the two groups; 66.6% of the Mirizzi syndrome patients applied cholecystectomy and placement of T-tube surgical procedures, and there were no postoperative complications. CONCLUSION Surgery is the definitive treatment of Mirizzi syndrome. Thus patients should have a correct preoperative diagnosis for an appropriate and safe surgery. We think that ERCP could be the best guide for this. Also, we believe that intraoperative cholangiography with ERCP and hybrid procedures for guiding surgical treatment may become an advanced treatment option in the future.
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Affiliation(s)
- Fatih Karaahmet
- Department of Gastroenterology, Atilim University Medical School
| | - Murat Kekilli
- Department of Gastroenterology, Gazi University Medical School, Ankara, Turkey
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Gómez D, Pedraza M, Cabrera LF, Mendoza Zuchini A, Arrieta G M, Aparicio BS, Pulido J. Minimally invasive management of Mirizzi syndrome Va: Case series and narrative review of the literature. Cir Esp 2022; 100:404-409. [PMID: 35525486 DOI: 10.1016/j.cireng.2022.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/25/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Mirizzi's Syndrome (MS) is a rare pathology, known to be a challenge for the surgeon. In the surgical management, open approach vs laparoscopic is a topic of discussion due to anatomic variations. The aim of this study is to analyze our experience in the laparoscopic management of this condition in Type Va. METHODS We made a descriptive retrospective study of patients diagnosed with MS type Va and treated by laparoscopic approach from 2014 to 2019, in two high volume centers of Bogotá, Colombia. RESULTS 1073 patients who presented complications from gallstones were evaluated, of which 16 were diagnosed with MS type Va. 75% were females and 25% males; 80% presented jaundice and 90% abdominal pain; 12 patients showed cholecystoduodenal fistula and 4 cholecystocolic fistula. All patients underwent laparoscopic management, total cholecystectomy and fistula resection with primary closure was possible on a 100% of the patients. Conversion rate was 0%. The follow up was 18 months. CONCLUSION Laparoscopic management of MS is feasible and safe; the experience of the surgery group and selection of the patients is the key to a successful outcome.
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Affiliation(s)
- Daniel Gómez
- Departamento de Cirugía Laparoscópica Avanzada, Universidad Militar Nueva Granada, Bogotá, Colombia
| | | | | | | | - Manuel Arrieta G
- Cirugía General, Universidad de la Sabana, Chía, Cundinamarca, Colombia
| | | | - Jean Pulido
- Departamento de Medicina, Universidad El Bosque, Bogotá, Colombia
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Klekowski J, Piekarska A, Góral M, Kozula M, Chabowski M. The Current Approach to the Diagnosis and Classification of Mirizzi Syndrome. Diagnostics (Basel) 2021; 11:diagnostics11091660. [PMID: 34574001 PMCID: PMC8465817 DOI: 10.3390/diagnostics11091660] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/30/2021] [Accepted: 09/07/2021] [Indexed: 12/24/2022] Open
Abstract
Mirizzi syndrome occurs in up to 6% of patients with cholecystolithiasis. It is generally caused by external compression of the common hepatic duct by a gallstone impacted in the neck of the gallbladder or the cystic duct, which can lead to fistulisation. The aim of this review was to highlight the proposed classifications for Mirizzi syndrome (MS) and to provide an update on modern approaches to the diagnosis of this disease. We conducted research on various internet databases and the total number of records was 993, but after a gradual process of elimination our final review consisted of 21 articles. According to the literature, the Cesendes classification is the most commonly used, but many new suggestions have appeared. Our review shows that the ultrasonography (US) is the most frequently used method of initial diagnosis, despite still having only average sensitivity. Magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) are good methods and are similarly effective, but only the latter can be simultaneously therapeutic. Some modern methods show very high sensitivity, but are not so commonly administered. Mirizzi syndrome is still a diagnostic challenge, despite the advancement of the available tools. Preoperative diagnosis is crucial to avoid complications during treatment. New research may bring a unification of classifications and diagnostic algorithms.
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Affiliation(s)
- Jakub Klekowski
- Student Research Group No 180, Faculty of Medicine, Wroclaw Medical University, 50-367 Wrocław, Poland; (J.K.); (A.P.); (M.G.); (M.K.)
| | - Aleksandra Piekarska
- Student Research Group No 180, Faculty of Medicine, Wroclaw Medical University, 50-367 Wrocław, Poland; (J.K.); (A.P.); (M.G.); (M.K.)
| | - Marta Góral
- Student Research Group No 180, Faculty of Medicine, Wroclaw Medical University, 50-367 Wrocław, Poland; (J.K.); (A.P.); (M.G.); (M.K.)
| | - Marta Kozula
- Student Research Group No 180, Faculty of Medicine, Wroclaw Medical University, 50-367 Wrocław, Poland; (J.K.); (A.P.); (M.G.); (M.K.)
| | - Mariusz Chabowski
- Division of Oncology and Palliative Care, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, 5 Bartla Street, 51-618 Wrocław, Poland
- Department of Surgery, 4th Military Teaching Hospital, 5 Weigla Street, 50-981 Wrocław, Poland
- Correspondence: ; Tel.: +48-261-660-247; Fax: +48-261-660-245
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Sgaramella LI, Gurrado A, Pasculli A, de Angelis N, Memeo R, Prete FP, Berti S, Ceccarelli G, Rigamonti M, Badessi FGA, Solari N, Milone M, Catena F, Scabini S, Vittore F, Perrone G, de Werra C, Cafiero F, Testini M. The critical view of safety during laparoscopic cholecystectomy: Strasberg Yes or No? An Italian Multicentre study. Surg Endosc 2021; 35:3698-3708. [PMID: 32780231 PMCID: PMC8195809 DOI: 10.1007/s00464-020-07852-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 07/24/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Laparoscopic cholecystectomy is considered the gold standard for the treatment of gallbladder lithiasis; nevertheless, the incidence of bile duct injuries (BDI) is still high (0.3-0.8%) compared to open cholecystectomy (0.2%). In 1995, Strasberg introduced the "Critical View of Safety" (CVS) to reduce the risk of BDI. Despite its widespread use, the scientific evidence supporting this technique to prevent BDI is controversial. METHODS Between March 2017 and March 2019, the data of patients submitted to laparoscopic cholecystectomy in 30 Italian surgical departments were collected on a national database. A survey was submitted to all members of Italian Digestive Pathology Society to obtain data on the preoperative workup, the surgical and postoperative management of patients and to judge, at the end of the procedure, if the isolation of the elements was performed according to the CVS. In the case of a declared critical view, iconographic documentation was obtained, finally reviewed by an external auditor. RESULTS Data from 604 patients were analysed. The study population was divided into two groups according to the evidence (Group A; n = 11) or absence (Group B; N = 593) of BDI and perioperative bleeding. The non-use of CVS was found in 54.6% of procedures in the Group A, and 25.8% in the Group B, and evaluating the operator-related variables the execution of CVS was associated with a significantly lower incidence of BDI and intraoperative bleeding. CONCLUSIONS The CVS confirmed to be the safest technique to recognize the elements of the Calot triangle and, if correctly performed, it significantly impacted on preventing intraoperative complications. Additional educational programs on the correct application of CVS in clinical practice would be desirable to avoid extreme conditions that may require additional procedures.
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Affiliation(s)
- Lucia Ilaria Sgaramella
- Unit of General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Policlinico, Piazza Giulio Cesare, 11, 70124 Bari, Italy
| | - Angela Gurrado
- Unit of General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Policlinico, Piazza Giulio Cesare, 11, 70124 Bari, Italy
| | - Alessandro Pasculli
- Unit of General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Policlinico, Piazza Giulio Cesare, 11, 70124 Bari, Italy
| | - Nicola de Angelis
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Henri Mondor Hospital, Université Paris-Est (UEP), Créteil, France
| | - Riccardo Memeo
- Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, Bari, Italy
| | - Francesco Paolo Prete
- Unit of General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Policlinico, Piazza Giulio Cesare, 11, 70124 Bari, Italy
| | - Stefano Berti
- Department of General Surgery, “Sant’Andrea” Hospital La Spezia, La Spezia, Italy
| | - Graziano Ceccarelli
- Division of General Surgery, Department of Surgery, San Donato Hospital, via Pietro Nenni 20-22, 52100 Arezzo, Italy
| | | | | | - Nicola Solari
- Department of Surgery, IRCSS Ospedale Policlinico San Martino, Genova, Italy
| | - Marco Milone
- Department of Clinical Medicine and Surgery, Federico II” University, Napoli, Italy
| | - Fausto Catena
- Department of Emergency and Trauma Surgery, Parma University Hospital, Parma, Italy
| | - Stefano Scabini
- Department of Surgery, IRCSS Ospedale Policlinico San Martino, Genova, Italy
| | - Francesco Vittore
- Unit of General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Policlinico, Piazza Giulio Cesare, 11, 70124 Bari, Italy
| | - Gennaro Perrone
- Department of Emergency and Trauma Surgery, Parma University Hospital, Parma, Italy
| | - Carlo de Werra
- Department of Clinical Medicine and Surgery, Federico II” University, Napoli, Italy
| | - Ferdinando Cafiero
- Department of Surgery, IRCSS Ospedale Policlinico San Martino, Genova, Italy
| | - Mario Testini
- Unit of General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Policlinico, Piazza Giulio Cesare, 11, 70124 Bari, Italy
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Gómez D, Pedraza M, Cabrera LF, Mendoza Zuchini A, Arrieta G M, Aparicio BS, Pulido J. Minimally invasive management of Mirizzi syndrome Va: Case series and narrative review of the literature. Cir Esp 2021; 100:S0009-739X(21)00169-X. [PMID: 34082891 DOI: 10.1016/j.ciresp.2021.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/21/2021] [Accepted: 04/25/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Mirizzi's Syndrome (MS) is a rare pathology, known to be a challenge for the surgeon. In the surgical management, open approach vs laparoscopic is a topic of discussion due to anatomic variations. The aim of this study is to analyze our experience in the laparoscopic management of this condition in Type Va. METHODS We made a descriptive retrospective study of patients diagnosed with MS type Va and treated by laparoscopic approach from 2014 to 2019, in two high volume centers of Bogotá, Colombia. RESULTS 1073 patients who presented complications from gallstones were evaluated, of which 16 were diagnosed with MS type Va. 75% were females and 25% males; 80% presented jaundice and 90% abdominal pain; 12 patients showed cholecystoduodenal fistula and 4 cholecystocolic fistula. All patients underwent laparoscopic management, total cholecystectomy and fistula resection with primary closure was possible on a 100% of the patients. Conversion rate was 0%. The follow up was 18 months. CONCLUSION Laparoscopic management of MS is feasible and safe; the experience of the surgery group and selection of the patients is the key to a successful outcome.
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Affiliation(s)
- Daniel Gómez
- Departamento de Cirugía Laparoscópica Avanzada, Universidad Militar Nueva Granada, Bogotá, Colombia
| | | | | | | | - Manuel Arrieta G
- Cirugía General, Universidad de la Sabana, Chía, Cundinamarca, Colombia
| | | | - Jean Pulido
- Departamento de Medicina, Universidad El Bosque, Bogotá. Colombia
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Zhao J, Fan Y, Wu S. Safety and feasibility of laparoscopic approaches for the management of Mirizzi syndrome: a systematic review. Surg Endosc 2020; 34:4717-4726. [PMID: 32661708 DOI: 10.1007/s00464-020-07785-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 07/02/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Laparoscopic approaches for the management of Mirizzi syndrome (MS) are controversial and challenging procedures for high conversion rate. This review aims at evaluating their safety and feasibility. METHODS We reviewed studies related to the laparoscopic approaches for the management of MS with detailed data of articles from January 2009 to December 2019 found in PubMed. RESULTS From 63 articles, we reviewed 17 articles detailing laparoscopic approaches for MS. There were 857 patients with MS; 432 of which were identified from 73,842 patients underwent cholecystectomy. Laparoscopic approaches were attempted in 440 patients and were successful in 290. The conversion rate was 34.09%. Various methods including laparoscopic cholecystectomy, laparoscopic subtotal cholecystectomy, laparoscopic common bile duct exploration (LCBDE) and (LTCBDE) were performed. The preoperative diagnosis of MS was made in 338 of 500 patients (67.60%). The mean operating time ranged from 49.7 ± 27.5 min to 270.5 ± 65.5 min, and the mean intraoperative bleeding varied from 21.1 ± 15.9 ml to 162.81 ± 40.83 ml. The mean hospital stay varied from 4.5 ± 3.7 to 7.21 ± 1.61 days. Postoperative complications occurred in 27 patients. CONCLUSIONS Various laparoscopic approaches are safe and feasible for the treatment of MS in the hands of experienced laparoscopic surgeons, especially for type I and II of Csendes classification. Definitive preoperative diagnosis and earlier management are essential.
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Affiliation(s)
- Jiannan Zhao
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ying Fan
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China.
| | - Shuodong Wu
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
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Abstract
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 post-operative 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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Mannino M, Toro A, Teodoro M, Coccolini F, Sartelli M, Ansaloni L, Catena F, Di Carlo I. Open conversion for laparoscopically difficult cholecystectomy is still a valid solution with unsolved aspects. World J Emerg Surg 2019; 14:7. [PMID: 30820240 PMCID: PMC6380008 DOI: 10.1186/s13017-019-0227-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 02/10/2019] [Indexed: 12/24/2022] Open
Abstract
The difficult laparoscopic cholecystectomy remains a surgical challenge for surgeons who must decide between laparoscopic continuation and open conversion. The balance between the lack of open surgery training of young surgeons and the risk of maintaining the laparoscopic approach in difficult laparoscopic cholecystectomy is still an unresolved problem. Furthermore, the time that must be spent in an attempt to complete laparoscopic surgery before conversion is still controversial. The authors in this letter discuss about these and other questions that still require an answer.
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Affiliation(s)
- M Mannino
- 1Department of Surgical Sciences and Advanced Technologies "GF Ingrassia", Cannizzaro Hospital, University of Catania, Via Messina, 829, 95126 Catania, Italy
| | - A Toro
- Department of Surgery, Augusta Hospital, Augusta, SR Italy
| | - M Teodoro
- 1Department of Surgical Sciences and Advanced Technologies "GF Ingrassia", Cannizzaro Hospital, University of Catania, Via Messina, 829, 95126 Catania, Italy
| | - F Coccolini
- 3General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - M Sartelli
- Department of Surgery, Macerata Hospital, Macerata, Italy
| | - L Ansaloni
- 3General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - F Catena
- 5Emergency Surgery, Parma Hospital, Parma, Italy
| | - I Di Carlo
- 1Department of Surgical Sciences and Advanced Technologies "GF Ingrassia", Cannizzaro Hospital, University of Catania, Via Messina, 829, 95126 Catania, Italy
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Mirizzi Syndrome: Diagnosis and Management of a Challenging Biliary Disease. Can J Gastroenterol Hepatol 2018; 2018:6962090. [PMID: 30159303 PMCID: PMC6109484 DOI: 10.1155/2018/6962090] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/11/2018] [Accepted: 08/01/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Mirizzi syndrome is a condition difficult to diagnose and treat, representing a particular "challenge" for the biliary surgeon. The disease can mimic cancer of the gallbladder, causing considerable diagnostic difficulties. Furthermore, it increases the risk of intraoperative biliary injury during cholecystectomy. The aim of this study is to point out some particular aspects of diagnosis and treatment of this condition. METHODS The clinical records of patients with Mirizzi syndrome, treated in the last five years, were reviewed. Clinical data, cholangiograms, preoperative diagnosis, operative procedures, and early and late results were examined. RESULTS Eighteen consecutive patients were treated in the last five years. Presenting symptoms were jaundice, pain, and cholangitis. Preoperative diagnosis of Mirizzi syndrome was achieved in 11 patients, while 6 had a diagnosis of gallbladder cancer and 1 of Klatskin tumor. Seventeen patients underwent surgery, including cholecystectomy in 8 cases, bile duct repair over T-tube in 3 cases, and hepaticojejunostomy in 4 cases. Two cases (11.1%) of gallbladder cancer associated with the Mirizzi syndrome were incidentally found: a patient underwent right hepatectomy and another patient was unresectable. The overall morbidity rate was 16.6%. There was no postoperative mortality. An ERCP with stent insertion was required in three cases after surgery. Sixteen patients were asymptomatic at a mean distance of 24 months (range: 6-48) after surgery. CONCLUSIONS Mirizzi syndrome requires being treated by an experienced biliary surgeon after a careful assessment of the local situation and anatomy. The preoperative placement of a stent via ERCP can simplify the surgical procedure.
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Abstract
Mirizzi Syndrome is a rare and challenging clinical entity to manage. However, recent advances in technology have provided surgeons with new options for more effective diagnosis and treatment of this condition. This paper reviews these new diagnostic modalities and treatment approaches for the management of Mirizzi Syndrome.An online search language was performed using PubMed and Web of Science for literature published in English between 2012 and 2017 using the search terms "Mirizzi Syndrome" and "Mirizzi." In total, 16 case series and 11 case reports were identified and analyzed.The most frequently used diagnostic modalities were ultrasound, computed tomography (CT); magnetic resonance cholangiopancreaticography (MRCP); endoscopic retrograde cholangiopancreaticography (ERCP). A combination of ≥2 diagnostic modalities was frequently used to detect Mirizzi Syndrome. Literature shows that the specific type of Mirizzi Syndrome determined the type of treatment chosen. Open surgery was the preferred option, although there are documented cases of the use of minimally-invasive techniques, even in advanced cases. Laparoscopic, endoscopic or robot-assisted surgery, used individually or in combination with lithotripsy, were all associated with a favorable outcome.As yet, there are no internationally-accepted guidelines for the management of Mirizzi Syndrome. Laparotomy is the preferred surgical technique of choice, although an increasing number of surgeons are beginning to opt for minimally-invasive techniques. The number of papers in the existing literature describing diagnostic and treatment procedures is relatively small at present, thus making it difficult to reasonably propose an evidence-based standard of care for Mirizzi Syndrome.
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Affiliation(s)
- Hang Chen
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ernest Amos Siwo
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Megan Khu
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri
| | - Yu Tian
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
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