Mirizzi Syndrome: An Experience in Laparoscopic Era
DOI:
https://doi.org/10.51985/JBUMDC2021027Keywords:
Cholecystectomy, Cholangiopancreaticography, Hepaticojejunostomy, Mirizzi Syndrome.Abstract
Objective: To assess the presentation and surgical management of Mirrizi syndrome patients who underwent Laparoscopic
Cholecystectomy.
Study Design and Setting: Retrospective Descriptive Study was conducted at Surgical Department Combined Military
Hospital 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. All
cases 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. Age
ranged 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 case
where partial cholecystectomy was done. T-tube closure of common bile duct was done in all Type-II MS. Similarly Ttube closure was possible in two cases of type-III while one had Roux-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
References
Capoor MR, Nair D, Rajni, Khanna G, Krishna SV, Chintamani
MS et al. Microflora of bile aspirates in patients with acute
cholecystitis with or without cholelithiasis: A tropical
experience. Braz J Infect Dis 2008 ;12: 222-5 DOI: https://doi.
org/ 10.1590 /S1413-86702008000300012
Shafique MS, Ahmad R, Ahmad SH, Hassan SW, Khan JS.
Gallstones in Young Population. Ulutas Med J. 2018;4(3):131-
DOI: https://doi.org/10.5455/umj.20180324011035
Gandhi D, Ojili V, Nepal P, Nagar A, Hernandez-Delima FJ,
Bajaj D, Choudhary G, Gupta N, Sharma P. A pictorial review
of gall stones and its associated complications. Clin Imaging.
;60(2):228-236. DOI: https://doi.org/ 10.1016/ j.clinimag.
11.015.
Clemente G., Tringali A., Rose AM De, Murazio M., Nuzzo
G., Giuliante F. Mirizzi Syndrome : diagnosis and management
of a challenging biliary disease. Can. J. Gastroenterol. Hepatol.
;2018 DOI: https://doi.org/10.1155/2018/6962090
Valderrama-Treviño AI, Granados-Romero JJ, Espejel-Deloiza
M, Chernitzky-Camaño J, Mera BB, Estrada-Mata AG,
Ceballos-Villalva JC, Campos JA, Argüero-Sánchez R. Updates
in Mirizzi syndrome. Hepatobiliary surgery and nutrition.
;6(3):170. DOI: https://doi.org/10.21037/hbsn.2016.11.01
Tataria RD, Salgaonkar HP, Maheshwari G, Halder PJ. Mirizzi's
syndrome: A scoring system for preoperative diagnosis. Saudi
J Gastroenterol. 2018;24(5):274-281. DOI: https://doi.org/
4103/sjg.
Gelbard R, Khor D, Inaba K, Okoye O, Szczepanski C,
Matsushima K, Strumwasser A, Rhee P, Demetriades D. Role
of Laparoscopic Surgery in the Current Management of Mirizzi
Syndrome. Am Surg. 2018;84(5):667-671. PMID: 29966566.
https://doi.org/10.1016/j.jamcollsurg.2016.08.283
HAN H, Akhter SQ, Rabbi H, Islam K, Talukder MT, Islam
MA. Mirizzi syndrome: diagnosis and management of a
challenging biliary disease. BIRDEM [Internet]. 30Dec.2019
[cited 4Apr.2021];10(1):7-DOI: https://doi.org/ 10.3329/
birdem.v10i1.44740
Payá-Llorente C, Vázquez-Tarragón A, Alberola-Soler A,
Martínez-Pérez A, Martínez-López E, Santarrufina-Martínez
S, Ortiz-Tarín I, Armañanzas-Villena E. Mirizzi syndrome:
a new insight provided by a novel classification. Annals of
Hepato-biliary-pancreatic Surgery. 2017;21(2):67-75. DOI:
https://doi.org/10.14701/ahbps.2017.21.2.67
Milone, M., Musella, M., Maietta, P. et al. Acute acalculous
cholecystitis determining Mirizzi syndrome: case report and
literature review. BMC Surg 14, 90 (2014). https://doi.org/
1186/1471-2482-14-90
Mishra MC, Vashishtha S, Tandon R. Biliobiliary fistula:
preoperative diagnosis and management implications. Surgery.
;108(5):835-9. PMID: 2237763.
Redaelli CA, Büchler MW, Schilling MK, et al. High
coincidence of Mirizzi syndrome and gallbladder carcinoma.
Surgery 1997; 121:58. DOI: https://doi.org/10.1016/S0039-
(97)90183-5
Xu XQ, Hong T, Li BL, Liu W, Xe XD, Zheng CJ. Mirizzi
Syndrome: Our experience with 27 cases in PUMC Hospital;
Clin Med Sci J. 201;28.172-7.DOI: https://doi.org/ 10.1016
/S1001-9294(13)60044-9
Erben Y, Benavente-chenhalls LA, Donohue JM, Que FG,
Kendrick ML, Reid-lombardo KM et al. Diagnosis and
treatment of Mirizzi syndrome:23 years Mayo clinic
experience. J Am Coll Surg 2011; 213.114-9. https://doi.
org/10.1016/j.jamcollsurg.2011.03.008
Mithani R, Schwesinger WH, Bingener J, Sirinek KR, Gross
GW: The Mirizzi syndrome: multidisciplinary management
promotes optimal outcomes. J Gastrointest Surg 2008; 12:
–28. DOI: https://doi.org/10.1007/s11605-007-0305-x
Payá-Llorente C, Vázquez-Tarragón A, Alberola-Soler A,
Martínez-Pérez A, Martínez-López E, Santarrufina-Martínez
S, Ortiz-Tarín I, Armañanzas-Villena E. Mirizzi syndrome:
a new insight provided by a novel classification. Annals of
Hepato-biliary-pancreatic Surgery. 2017;21(2):67-75. DOI:
https://doi.org/10.14701/ahbps.2017.21.2.67
Csendes A, Diaz JC, Burdiles P, Maluenda F, Nava O. Mirizzi
syndrome and cholecystobiliary fistula: a unifying
classification. Br J Surg 1989; 76:1139-43. DOI: https://doi.
org/10.1002/bjs.1800761110
Ibrarullah M, Saxena R, Sikora SS. Mirizzi's syndrome:
identification and management strategy. Aust N Z J Surg
; 63:802. DOI: https://doi.org/10.1111/j.1445-
1993.tb00344.x
Antoniou SA, Antoniou GA, Makridis C. laparoscopic
treatment of Mirizzzi syndrome: a systematic review. Surg
Endosc 2010;24:33. DOI: https://doi.org/10.1007/s00464-
-0520-5
Parsad TL, Kumar A, Sikora SS. Mirizzi syndrome and
gallbladder cancer. J Hepatobiliary Pancreat Surg 2006;13:323.
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