Clinical patterns of postcholecystectomy syndrome.

BACKGROUNDS/AIMS: Postcholecystectomy syndrome represents a heterogeneous group of symptoms and findings in patients who have previously undergone cholecystectomy. It is rare and under-reported in Saudi Arabia. It can be attributed to many complications such as bile duct injury, biliary leak, retained common bile duct stones, recurrent bile duct stones, and bile duct strictures. In this study, we aimed to analyze the causes and evaluate the approach to postcholecystectomy syndrome in our local Saudi Arabian community because of the vast number of cases encountered in our hospital for gallbladder clinical conditions and its related complications. METHODS: A prospective cohort database analysis of 272 patients who were diagnosed and treated for postcholecystectomy syndrome between January 2000 and December 2013 were reviewed. RESULTS: The incidence rate of postcholecystectomy syndrome was 19.8%. The male to female ratio was 1:1.45. The mean age was 37.41±7.12 years. The most common causes were as follows: No obvious cause in 50 (18.4%) patients, Helicobacter pylori infection in 43 (15.8%), pancreatitis in 42 (15.4%), peptic ulcer disease in 41 (15.1%), recurrent common bile duct (CBD) stone in 26 (9.6%), retained CBD stone in 22 (8.1%), bile leakage in 19 (7%), stenosis of the sphincter of Oddi in 12 (4.4%), cystic duct stump syndrome in 11 (4%), and CBD Stricture in 5 (1.8%). The mortality rate was 0%. CONCLUSIONS: Any clinical presentation of postcholecystectomy should not be underestimated and be thoroughly investigated. Multidisciplinary collaboration is crucial for the best outcome and a safe approach for all the patients.

Mirizzi syndrome: necessity for safe approach in dealing with diagnostic and treatment challenges.

BACKGROUNDS/AIMS: The challenging dilemma of Mirizzi syndrome for operating surgeons arises from the difficulty to diagnose it preoperatively, and approximately 50% of cases are diagnosed intraoperatively. In this study, we analysed the effectiveness of diagnostic modalities and treatment options in our series of Mirizzi syndrome. METHODS: Patients had a preoperative or intraoperative diagnosis of Mirizzi syndrome, and were classified into three groups: Group 1: Incidental finding of Mirizzi syndrome intraoperatively (n=34). Group 2: Patients presented with jaundice, diagnosed by endoscopic retrograde cholangiopancreatography (n=17). Group 3: Patients diagnosed initially by ultrasound (n=13). Laparoscopic cholecystectomy was conducted in all 49 patients with Cendes type I disease. Partial cholecystectomy, common bile duct exploration, repair of fistula and t-tube placement was conducted on eight patients with Cendes type II and five patients with Cendes type III. Partial cholecystectomy with Roux-en-Y hepaticojejunostomy was conducted in two patients with Cendes type IV disease. RESULTS: Sixty-four patients were diagnosed with Mirizzi syndrome. Morbidity rate was 3.1%. Mortality rate was 0%. Group 3 (patients diagnosed initially by ultrasound) had the best treatment outcome, the least morbidity, and the shortest hospital stay. CONCLUSIONS: Suspected cases of Mirizzi syndrome should not be underestimated. Difficulty in establishing preoperative diagnosis is the major dilemma. As it is mostly encountered intraoperatively, the approach should be careful and logical to identify the correct type of Mirizzi by a thorough diagnostic laparoscopy and thus, provide optimum treatment for the subtype to achieve the best outcome.