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Laparoscopic versus open surgical management of patients with Mirizzi's syndrome: A comparative study
Hirdaya Hulas Nag1, Phani Kumar Nekarakanti1
1Department of GI Surgery, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, India.
Introduction:
Open surgical management is considered as 'standard of care' for patients with Mirizzi's syndrome (MS). Laparoscopic management of MS has been reported, but comparative studies are lacking.
Patients And Methods:
This retrospective study included patients with MS who were treated by a single surgical team from May 2009 to December 2017. Patients with total laparoscopic surgery were included in laparoscopic group (LG) and patients with total open surgery were included in open group (OG). Patients with conversion to open surgery and patients with gallbladder cancer (GBC) were excluded from the study.
Results:
Total patients were 75; six patients with GBC and 11 patients with open conversion were excluded from comparison. LG had 32 patients and OG had 26 patients. Demographic, clinical and laboratory parameters were similar. Laparoscopic versus open preoperative diagnosis rate was 87.5% versus 69.2% (P = 0.08), respectively. OG had a large number of patients with concomitant bile duct stone; therefore, bile duct exploration rate was higher in OG (P = 0.009). Laparoscopic versus open, mean duration of surgery - 137 min versus 145 min (P = 0.664); mean blood loss - 45 mL versus 70 mL (P = 0.04); mean hospital stay - 4.5 versus 8.1 days (P = 0.027). Post-operative complication rate was 21.8% in LG and 42.3% in OG (P = 0.355); bile leak was noted in OG only (P = 0.042). LG versus OG mean follow-up was 50 versus 38 months (P = 0.189); no remote complication was observed in both groups.
Conclusion:
The results of laparoscopic surgery in patients with Mirizzi's syndrome are not inferior to that of open surgery; rather it may help to improve perioperative outcome in selected patients.