[Endoscopic interventions in diagnosis and treatment of Mirizzi syndrome]. / Endoskopicheskie vmeshatel'stva v diagnostike i lechenii sindroma Mirizi.

AIM: To define the role of endoscopic interventions in diagnosis and treatment of Mirizzi syndrome. MATERIAL AND METHODS: Results of treatment of 41 patients with Mirizzi syndrome are presented. Endoscopic transpapillary interventions including cholangiography, papillosphincterotomy lithoextraction, nazobiliary drainage were used as a first step in all cases. RESULTS AND DISCUSSION: In 4 cases laparoscopic cholecystectomy was performed after biliary tree sanitation. In 6 advanced age patients with severe comorbidities common bile duct stenting alone was preferred. Open interventions were performed in 15 patients (36.6%) including cholecystectomy, choledocholithotomy with common bile duct drainage. CONCLUSION: It is shown that endoscopic transpapillary methods of diagnosis and treatment of Mirizzi syndrome provides adequate decompression and sanitation of the bile ducts in most cases and significantly reduces number of open surgical procedures.

Mirizzi syndrome: our experience with 27 cases in PUMC Hospital.

OBJECTIVE: To retrospectively evaluate the diagnosis and treatment of Mirizzi syndrome (MS). METHODS: Patients who received elective or emergency cholecystectomies in our center during 23 years were retrospectively evaluated. The data reviewed included demography, clinical presentations, diagnostic methods, surgical procedures, postoperative complications, and follow-up. RESULTS: There were 27 patients diagnosed with MS among 8697 cholecystectomies performed during that period. The preoperative diagnostic modalities included ultrasonography, computed tomography, magnetic resonance cholangiopancreatography, and endoscopic retrograde cholangiopancreatography. The incidence of MS Type I (12/27, 44.4%) had the dominance in the four types, the incidence of MS Type II and III were 33.3% (9/27) and 22.2% (6/27), and there were no MS Type IV patients. Laparoscopic cholecystectomy was performed in 15 (55.6%) patients, but only 3 (11.1%) patients with MS Type I had a successful surgery, and the other 12 were converted to open cholecystectomy. The remaining 12 patients directly underwent open cholecystectomy. The surgical procedures except laparoscopic cholecystectomy included simply open cholecystectomy (including laparoscopic cholecystectomy converted to open cholecystectomy) (6/27, 22.2%), open cholecystectomy, T-tube placement with choledochotomy (9/27, 33.3%), open cholecystectomy, closure of the fistula with gallbladder cuff, T-tube placement (3/27, 11.1%), and open cholecystectomy with excision of the external bile ducts, and Roux-en-Y hepatico-jejunostomy (6/27, 22.2%). Of them, 88.9% (24/27) patients recovered uneventfully and were discharged in good condition without any operation related mortality. CONCLUSIONS: Endoscopic retrograde cholangiopancreatography is a good method with diagnostic and therapeutic purposes. Total or partial cholecystectomy is generally adequate for MS Type I. For MS Type II-IV, paritial cholecystectomy, choledochoplasty, or if impossible, Roux-en-Y hepatico-jejunostomy may be performed. Laparoscopic cholecystectomy may be successful in selected preoperatively diagnosed MS Type I patients, and open cholecystectomy is the standard therapeutic method.