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Mirizzi syndrome: our experience with 27 cases in PUMC Hospital
Xie-qun Xu1, Tao Hong, Bing-lu Li
1Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
Objective:
To retrospectively evaluate the diagnosis and treatment of Mirizzi syndrome (MS).
Methods:
Patients who received elective or emergency cholecystectomies in our center during 23 years were retrospectively evaluated. The data reviewed included demography, clinical presentations, diagnostic methods, surgical procedures, postoperative complications, and follow-up.
Results:
There were 27 patients diagnosed with MS among 8697 cholecystectomies performed during that period. The preoperative diagnostic modalities included ultrasonography, computed tomography, magnetic resonance cholangiopancreatography, and endoscopic retrograde cholangiopancreatography. The incidence of MS Type I (12/27, 44.4%) had the dominance in the four types, the incidence of MS Type II and III were 33.3% (9/27) and 22.2% (6/27), and there were no MS Type IV patients. Laparoscopic cholecystectomy was performed in 15 (55.6%) patients, but only 3 (11.1%) patients with MS Type I had a successful surgery, and the other 12 were converted to open cholecystectomy. The remaining 12 patients directly underwent open cholecystectomy. The surgical procedures except laparoscopic cholecystectomy included simply open cholecystectomy (including laparoscopic cholecystectomy converted to open cholecystectomy) (6/27, 22.2%), open cholecystectomy, T-tube placement with choledochotomy (9/27, 33.3%), open cholecystectomy, closure of the fistula with gallbladder cuff, T-tube placement (3/27, 11.1%), and open cholecystectomy with excision of the external bile ducts, and Roux-en-Y hepatico-jejunostomy (6/27, 22.2%). Of them, 88.9% (24/27) patients recovered uneventfully and were discharged in good condition without any operation related mortality.
Conclusions:
Endoscopic retrograde cholangiopancreatography is a good method with diagnostic and therapeutic purposes. Total or partial cholecystectomy is generally adequate for MS Type I. For MS Type II-IV, paritial cholecystectomy, choledochoplasty, or if impossible, Roux-en-Y hepatico-jejunostomy may be performed. Laparoscopic cholecystectomy may be successful in selected preoperatively diagnosed MS Type I patients, and open cholecystectomy is the standard therapeutic method.
Insights
Mirizzi syndrome (MS) diagnosis and treatment were evaluated in 27 patients. Open cholecystectomy remains the standard treatment, with laparoscopic approaches suitable for select cases. Most patients recovered well.
Area of Science:
- Gastroenterology
- Hepatobiliary Surgery
- Surgical Diagnostics
Background:
- Mirizzi syndrome (MS) is a rare condition caused by extrinsic compression of the common hepatic duct or cystic duct by impacted gallstones in the gallbladder neck or cystic duct.
- Accurate diagnosis and appropriate surgical management are crucial for favorable patient outcomes.
Purpose of the Study:
- To retrospectively evaluate the diagnostic methods and treatment strategies for Mirizzi syndrome (MS).
- To analyze the incidence, clinical presentation, and surgical outcomes of MS patients.
Main Methods:
- Retrospective review of 8697 cholecystectomies over 23 years.
- Analysis of patient demographics, clinical data, diagnostic imaging (ultrasonography, CT, MRCP, ERCP), surgical procedures, and postoperative outcomes.
- Classification of MS cases into types I, II, and III based on imaging and intraoperative findings.
Main Results:
- 27 cases of MS were identified (0.31% incidence).
- MS Type I was most common (44.4%), followed by Type II (33.3%) and Type III (22.2%).
- Laparoscopic cholecystectomy was attempted in 15 patients, with conversion to open surgery in 12 (80%) due to MS complexity. Open cholecystectomy was the primary approach for most patients, with various reconstructive techniques employed.
- Overall, 88.9% of patients recovered uneventfully without mortality.
Conclusions:
- Endoscopic retrograde cholangiopancreatography (ERCP) offers both diagnostic and therapeutic benefits for MS.
- Type I MS can often be managed with simple or partial cholecystectomy.
- For Types II-IV, more complex procedures like choledochoplasty or Roux-en-Y hepatico-jejunostomy may be necessary.
- Open cholecystectomy is the established standard for MS treatment, while laparoscopic approaches are feasible in carefully selected, preoperatively diagnosed Type I cases.
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