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[Mirizzi syndrome--a contraindication for laparoscopic surgery]
J J Moser1, H U Baer, A Glättli
1Klinik für Viszerale und Transplantationschirurgie, Inselspital Bern.
Helvetica Chirurgica Acta
|March 1, 1993
Summary
Mirizzi syndrome, a bile duct obstruction, is classified into two types. Treatment involves partial cholecystectomy, with Type II also requiring bilio-digestive anastomosis for effective management.
Area of Science:
- Gastroenterology
- Hepatobiliary Surgery
Background:
- Mirizzi syndrome causes obstructive jaundice due to gallstones in the cystic duct or gallbladder neck.
- McSherry's classification distinguishes Type I (external compression) and Type II (cholecysto-choledochal fistula).
Purpose of the Study:
- To present a surgical concept for treating Mirizzi syndrome.
- To evaluate the efficacy and safety of this treatment approach.
Main Methods:
- Retrospective analysis of 10 patients treated between 1986-1991.
- Surgical approach involved partial cholecystectomy, with Type II cases also receiving bilio-digestive anastomosis.
- Management considered challenges of dense adhesions and edema in the hepato-duodenal ligament.
Main Results:
- Successful treatment of 10 patients (7 Type II, 3 Type I) with no mortality or biliary system injury.
- One patient required reoperation for hemorrhage and biliary fistula.
- One patient developed a benign stricture, successfully dilated.
- Two patients incidentally found to have gallbladder carcinoma.
Conclusions:
- The described surgical concept offers a safe and effective treatment for Mirizzi syndrome.
- Partial cholecystectomy, with or without bilio-digestive anastomosis, is appropriate for Types I and II respectively.
- Careful surgical planning is essential due to potential operative field complications.