Management of Mirizzi Syndrome Type II

Mirizzi syndrome (MS) with cholecystobiliary fistula (type II McSherry classification) is a rare complication of cholelithiasis. Accurate diagnosis is important in the management of MS type II. ERCP provides biliary decompression, and in some cases, endoscopic lithoextraction can be achieved. Surgery is the primary method in the management of MS type II. The aim of this study was to report and assess our experience of MS type II management in terms of different treatment modalities, such as endoscopic lithoextraction, open surgery, and laparoscopy.

A retrospective review of a prospectively maintained database of 30 patients with MS type II between January 2009 and May 2025 was performed. Demographic, clinical, laboratory, visualization, operative, and postoperative data were recorded.

ERCP was done in all 30 cases. Complete endoscopic stone removal was achieved in 9 (30%). Endoscopic decompression was not successful in 1 (3.3%) case. Adverse events after ERCP occurred in 4 (13.3%) cases. Nineteen patients were operated on, 8 (42%) by laparoscopy. Partial cholecystectomy with choledochoplasty by remaining gallbladder tissue in 8 cases; cholecystofistulolithotomy in 8; partial cholecystectomy with choledocholithotomy in 2; partial cholecystectomy with fistulolithotomy in 1. Minor adverse events were reported in 3 (15.6%) cases: wound infection in 2 after open procedures and pneumonia in 1 after laparoscopy.

Precise visualization data are the key to MS type II management. ERCP allows restoration of the bile outflow, and in a subset of patients, complete endoscopic stone extraction can be achieved. Surgical management of MS type II consists of stone removal through the gallbladder and/or fistula incision. With sufficient experience, laparoscopy can be applied. Cholecystofistulolithotomy without gallbladder removal may be a procedure of choice in MS type II management.