New insights on the therapeutic strategies for Mirizzi syndrome in the era of laparoscopy / 中华肝胆外科杂志

ABSTRACT

Mirizzi syndrome (MS) is a complication of chronic cholelithiasis,whose pathological changes are severe and complicated.The preoperative diagnosis rate of MS is rather low,and the intraoperative bile duct injury rate is rather high.In the past,MS was considered as a contraindication for laparoscopy,but in the recent decade,with the increasing understanding on pathological changes of MS,the improvement of laparoscopic technique and the accumulation of experience,laparoscopic therapy has been increasingly used in treating MS.The piling experience and knowledge have been modified and optimized the traditional treatment for MS mainly in the following 3 aspects.First,if the skills and experience permit,exploration and treatment of MS may be completed safely and efficiently in laparoscopic route.Second,biliary-enteric anastomosis should be avoided as much as possible in the treatment strategy of MS Ⅲ.Intraoperatively,the wall of cholecystobiliary fistula and the Hartmann's pouch should be retained as much as possible in order to aid in the closure of the destroyed bile duct.When exploration is not needed,MS Ⅲ can be successfully treated with this technique in most cases.When exploration is needed,bile duct incision both in upper and lower directions from the fistula and T tube placement through the fistula are suggested.Third,for MS Ⅳ,bile duct repair and T-tube drainage can be used as the preferred method,and biliary-enteric anastomosis can only be considered as a remedial measure when the bile duct is completely transected or the continuity is not satisfactory.