Mirizzi Syndrome-The Past, Present, and Future

Area of Science:

• Gastroenterology
• Hepatobiliary Surgery
• Surgical Complications

Background:

• Mirizzi syndrome arises from impacted gallstones causing bile duct compression and inflammation.
• It can lead to cholecystobiliary or cholecystoenteric fistulas, complicating gallstone disease.
• Clinical presentation is often non-specific, mimicking malignancy and delaying diagnosis.

Purpose of the Study:

• To review the classification, presentation, diagnosis, and management of Mirizzi syndrome.
• To highlight challenges in preoperative diagnosis and surgical risks.
• To discuss current treatment strategies and the need for a management consensus.

Main Methods:

• Review of existing literature on Mirizzi syndrome classification and clinical features.
• Analysis of diagnostic challenges and surgical approaches.
• Discussion of treatment options including cholecystectomy and adjunct procedures.

Main Results:

• The Csendes classification categorizes Mirizzi syndrome into five types based on fistula presence and severity.
• Preoperative diagnosis is challenging, with many cases identified intraoperatively, increasing risks.
• Cholecystectomy is the primary treatment; laparoscopic approaches are viable for simpler types, while subtotal may be needed for complex cases.

Conclusions:

• There is no universal consensus on Mirizzi syndrome management.
• Treatment decisions depend on surgical pathology extent and available expertise.
• Multidisciplinary collaboration is crucial for accurate diagnosis and optimal patient outcomes.