Minimally invasive surgical treatment of Mirizzi syndrome / 中华消化内镜杂志

ABSTRACT

Objective To study the method of combined laparoscopy and endoscopy ( duodenosco-py and choledochoscopy) in the treatment of Csendes's II, III Mirizzi Syndrome. Methods Twenty one patients with Mirizzi Syndrome were admitted for the procedures. These patients received endoscopic nasobiliary drainage first, followed by laparoscopic subtotal cholecystectomy plus common bile duct(CBD) exploration. Results Satisfactory out come was realized except conversion to open surgery occurred in 2 for failure in repairing due to the extensive adhesions of Calot's triangle and anatomical abnormalities of cystic duct. In the course of operation ,removal of incarcerated stones in neck of gallbladder was performed in 14 cases, extraction of CBD stones by intraoperative choledochoscopy in 5 cases, and all cases received primary suture on the defect of CBD. There was neither residual stones left nor serious after - effect including biliary fistula and he-mobilia. Mean postoperative stay was 9.4 days. Follow - up observations on 19 patients did not show recurrence of stones, nor bile duct stricture during 18-41 months. Conclusion The combined procedures is feasible and safe alternative but can be technically demanding. This management is able to substitute some conventional procedure of T - tube insertion, however, primary suture on the defect bile duct is especially difficult.