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Mirizzi Syndrome: Optimal Timing and Management.
Rogelio E Molina1, David M Rosenberg1, Julia E Burrows1
1Department of Surgery, Harbor UCLA Medical Center, Torrance, CA, USA.
The American Surgeon
|April 11, 2026
Summary
Preoperative diagnosis of Mirizzi syndrome improves surgical outcomes. Delayed surgery for advanced Mirizzi syndrome is safe, allowing for specialized care and potentially reducing complications.
Area of Science:
- Hepatobiliary Surgery
- Surgical Outcomes Research
- Gastroenterology
Background:
- Mirizzi syndrome is an uncommon (0.3-1.4%) yet challenging biliary complication.
- Lack of standardized surgical guidelines hinders optimal management strategies for Mirizzi syndrome.
Purpose of the Study:
- To evaluate postoperative outcomes in Mirizzi syndrome based on diagnosis timing, cholecystectomy timing, and surgical specialty.
- To identify factors influencing patient outcomes in Mirizzi syndrome cases.
Main Methods:
- Multi-center retrospective review of 65 Mirizzi syndrome cases from 2014-2023.
- Patients stratified using Csendes classification; outcomes analyzed by diagnosis and surgery timing, and surgical service.
Main Results:
- Preoperative diagnosis (25% complications) significantly reduced complications versus intraoperative diagnosis (57%, P=0.05).
- Complication rates were similar for index vs. delayed surgery in advanced Mirizzi syndrome (types II-Va).
- Overall complication rates were comparable between acute care and hepatopancreatobiliary surgery services.
Conclusions:
- Preoperative diagnosis of Mirizzi syndrome is linked to better postoperative outcomes.
- Type I Mirizzi syndrome is safely managed by acute care or hepatopancreatobiliary surgeons.
- Delayed surgery for advanced Mirizzi syndrome allows for specialized care and appears safe.
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