Mirizzi Syndrome: An Experience in Laparoscopic Era

Authors

  • Syed Mukarram Hussain
  • Asrar Ahmad
  • Muhammad Awais Mughal
  • Irum Saleem
  • Saqib Islam

DOI:

https://doi.org/10.51985/JBUMDC2021027

Keywords:

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.

DOI: https://doi.org/10.1007/s00534-005-1072-2

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Published

2021-10-12

How to Cite

Hussain, S. M. ., Ahmad, A. ., Mughal, M. A. ., Saleem, I. ., & Islam, S. (2021). Mirizzi Syndrome: An Experience in Laparoscopic Era. Journal of Bahria University Medical and Dental College, 11(4), 165–167. https://doi.org/10.51985/JBUMDC2021027

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Original Articles