[Mirizzi syndrome management (in Russian only)]

Area of Science:

• Hepatobiliary surgery
• Gastroenterology
• Diagnostic imaging

Background:

• Mirizzi syndrome presents diagnostic and therapeutic challenges, often leading to mechanical jaundice and cholangitis.
• Effective preoperative diagnosis and biliary decompression are essential for successful surgical management.

Purpose of the Study:

• To evaluate the effectiveness of a comprehensive approach including preoperative diagnosis, conservative treatment, and minimally invasive biliary decompression for Mirizzi syndrome.
• To analyze surgical outcomes in relation to the efficacy of minimally invasive biliary decompression.

Main Methods:

• A retrospective analysis of 67 patients with Mirizzi syndrome (aged 27-96 years).
• Diagnosis involved a multi-modal approach: clinical data, laboratory tests, X-ray, ultrasound, EGDS, CT, and MRI.
• Biliary decompression techniques included percutaneous transhepatic cholangiography, endoscopic retrograde cholangiopancreatography, cholecystocholangiography, and intraoperative cholangiography.

Main Results:

• Percutaneous transhepatic cholangiography and cholecystocholangiography were effective for Mirizzi syndrome type 1.
• Endoscopic retrograde cholangiopancreatography showed reduced diagnostic value and complications in type 2 cases.
• Antegrade biliary decompression combined with medication was 7 times more effective than retrograde decompression; percutaneous drainage was highly effective for type 1.
• Emergency surgery correlated with a ~60% mortality rate, while elective procedures had no deaths. Overall mortality was 11.9%.

Conclusions:

• Minimally invasive biliary decompression, particularly antegrade approaches, significantly impacts surgical outcomes in Mirizzi syndrome.
• Effective preoperative diagnosis and timely, appropriate biliary decompression are critical for reducing morbidity and mortality.
• Elective surgical intervention following successful decompression is associated with significantly better outcomes compared to emergency procedures.