Mirizzi syndrome: choice of surgical procedure in the laparoscopic era

Impaction of a calculus in gallbladder neck or cystic duct or even in its remnant may produce common hepatic duct stricture by direct mechanical impression or associated inflammation. This clinical entity is referred to as Mirizzi syndrome. Four patients were operated on for Mirizzi syndrome. This represents 0.9% of the 444 patients who underwent laparoscopic cholecystectomy in our clinic. Two cases with Mirizzi syndrome type I, one of which had a stone in a gallbladder remnant, were successfully treated by laparoscopic cholecystectomy without any complications. One patient developed a bile leakage; fistulography via a sump drain revealed bile leakage from the laceration site of the stone, and the patient was reoperated on to perform a Roux-en-Y hepaticojejunostomy. The patient was lost due to cardiopulmonary arrest originating from septic shock. In another case diagnosed as Mirizzi type II, the operation was converted to an open procedure due to intense inflammation and fibrosis around the area of the Calot's triangle. Subtotal cholecystectomy was done and the defect on the common hepatic duct repaired by means of a gallbladder flap over the T tube.