[Mirizzi Syndrome: Prevalence, diagnosis and treatment]

The Mirizzi syndrome was described by Pablo Luis Mirizzi in 1948, who emphasized this syndrome was characterized by the obstruction of the common hepatic duct due to mechanical compression caused by an impacted stone in the gallbladder neck or in the cystic duct. The incidence ranges from 0.05% to 4%.

We performed a retrospective cross-sectional study. Based on the database of the General Surgery Division of the Prof Alejandro Posadas National Hospital, between July 2007and June 2013, charts of all patients with biliary lithiasis disease operated in this period were analyzed. We analyzed the clinical features, the various diagnostic techniques and the treatment carried out in each of them.

Surgery due to biliary lithiasis was performed in 2,160 patients. Fourteen patients, 8 females and 6 males, had Mirizzi syndrome (0.65%). The mean age was 55.3 years old (range 34-70 years old). Four patients were scheduled for elective surgery and 10 were operated during emergency. Preoperative differential diagnosis was: extrahepatic cholestasis 10, cholecystitis 3 and biliary duct stenosis vs gallbladder cancer 1. The treatments performed were: 3 conventional cholecystectomies with intraoperative dynamic cholangiography, 2 conventional cholecystectomies plus choledochoplasty with Kehr tube, 2 laparoscopic cholecystectomies plus choledochoplasty with Kehr tube, 1 partial cholecystectomy with Pezzer catheterization, 3 choledochoduodenostomy, 1 choledochoplasty with gallbladder remnant, 1 hepaticojejunostomy and 1 treatment in two steps (percutaneous biliary drainage and cholecystectomy). Regarding complications, we observed 1 autolimited leak from the choledocoduodenostomy, 1 death in an ederly patient, and 1 hepatic abscess treated by a minimaly invasive approach.

Mirizzi syndrome is a disease with low prevalence, which must be taken into account in biliary surgery, because the treatment varies according to the intraoperative findings and the experience of the surgical team.