[Mirizzi syndrome: preoperative diagnosis and therapeutic management]

The Mirizzi syndrome describes a benign obstruction of the common hepatic duct due to a stone impacted within the cystic duct or in the Hartman's pouch of the gall bladder. The obstruction is caused either by external compression (Type I) or due to arrosion of the common hepatic wall creating a cholecysto-biliary fistula (Type II-IV). In a period of 16 months we encountered this rare cause of obstructive jaundice four times. We discuss the importance of preoperative diagnosis and a safe surgical management. Ultrasonography together with the laboratory findings of obstructive jaundice may lead to the suspicion of a Mirizzi syndrome. Often the endoscopic retrograde cholangiography confirms the diagnosis. Some authors report the successful treatment of Mirizzi syndrome by laparoscopic surgery. Nevertheless, we propose the open procedure because of the presence of dense inflammatory adhesions at the junction between the gallbladder and the common hepatic duct. Biliary-enteric bypass is often required to establish a sufficient biliary drainage. We consider laparoscopic techniques to be too dangerous.