Related Experiment Video
Updated: Mar 20, 2026
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Intra-cholecystic approach for laparoscopic management of Mirizzi's syndrome: A case series
Hirdaya H Nag1, Vageesh Bettageri Gangadhara1, Amit Dangi1
1Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India.
Introduction:
Laparoscopic management of patients with Mirizzi's syndrome (MS) is not routinely recommended due to the high risk of iatrogenic complications.
Patients And Methods:
Intra-cholecystic (IC) or inside-gall bladder (GB) approach was used for laparoscopic management of 16 patients with MS at a tertiary care referral centre in North India from May 2010 to August 2014; a retrospective analysis of prospectively collected data was performed.
Results:
Mean age was 40.1 ± 14.7 years, the male-to-female ratio was 1:3, and 9 (56.25%) patients had type 1 MS (MS1) and 7 (43.75%) had type 2 MS (MS2) (McSherry's classification). The laparoscopic intra-cholecystic approach (LICA) was successful in 11 (68.75%) patients, whereas 5 patients (31.25%) required conversion to open method. Median blood loss was 100 mL (range: 50-400 mL), and median duration of surgery was 3.25 h (range: 2-7.5 h). No major complications were encountered except 1 patient (6.5%) who required re-operation for retained bile duct stones. The final histopathology report was benign in all the patients. No remote complications were noted during a mean follow-up of 20.18 months.
Conclusion:
LICA is a feasible and safe approach for selected patients with Mirizzi's syndrome; however, a low threshold for conversion is necessary to avoid iatrogenic complications.
Insights
Laparoscopic intra-cholecystic approach (LICA) is a viable option for Mirizzi
Area of Science:
- Gastroenterology and Hepatobiliary Surgery
- Minimally Invasive Surgery
Background:
- Mirizzi's syndrome (MS) management via laparoscopy is challenging due to high complication risks.
- Traditional approaches often necessitate open surgery, increasing patient morbidity.
Purpose of the Study:
- To evaluate the feasibility and safety of a laparoscopic intra-cholecystic approach (LICA) for Mirizzi's syndrome.
- To assess outcomes and complication rates associated with LICA in MS patients.
Main Methods:
- Retrospective analysis of prospectively collected data from 16 patients with Mirizzi's syndrome.
- Utilized an intra-cholecystic (inside-gall bladder) laparoscopic technique.
- Data collected from May 2010 to August 2014 at a tertiary care center.
Main Results:
- The laparoscopic intra-cholecystic approach (LICA) was successful in 68.75% of patients.
- 5 patients (31.25%) required conversion to open surgery.
- No major complications were observed, with one patient needing re-operation for retained bile duct stones.
Conclusions:
- Laparoscopic intra-cholecystic approach (LICA) is a feasible and safe option for selected Mirizzi's syndrome patients.
- A low threshold for conversion to open surgery is crucial to mitigate iatrogenic complications.
- This technique offers a minimally invasive alternative for managing MS.
Related Concept Videos
01:29Appendicitis-II: Diagnostic Studies and Management
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD: