Complicated gallstone disease: diagnosis and management of Mirizzi syndrome

Kulkarni, Sagar; Hotta, Mayo; Sher, Linda; Selby, Rick; Parekh, Dilipkumar; Buxbaum, James; Stapfer, Maria

doi:10.1007/s00464-016-5219-9

Cited by 40 publications

(44 citation statements)

References 17 publications

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“…Ultrasonography is the most commonly used imaging procedure in the diagnosis of gallstones. The sensitivity of US for the diagnosis of Mirizzi syndrome ranges 8.3-62.7% [6,8,13,26]. However, in our series, none of the pre-operative US scans performed yielded a positive diagnosis.…”

Section: Discussioncontrasting

confidence: 53%

“…It is only achieved in 8-62.5% of cases [6]. In our series the [6,8,13,26]. It is considered a gold standard diagnostic tool, as it defines the cause, level and extent of biliary obstruction, as well as ductal abnormalities, including fistula [14,18].…”

Section: Discussionmentioning

confidence: 85%

“…Patients with Mirizzi syndrome and biliary-enteric fistulas associated with gallbladder cancer have been reported. The main risk factors for gallbladder cancer are longstanding gallstone disease and stasis, which are also present in Mirizzi syndrome [5,6,13,17]. There are no clinical features that help differentiate between a Mirizzi syndrome and a gallbladder cancer.…”

Section: Discussionmentioning

confidence: 99%

“…Obstructive jaundice and abdominal pain are the most frequent symptoms found in these patients [4,10]. Diagnostic sensitivity of imaging tests is variable, ranging between 13% for ultrasound (US), 31% for computed tomography (CT), 76% for magnetic resonance cholangiopancreatography (MRCP), and 58% for endoscopic retrograde cholangiopancreatography (ERCP) [13]. Surgical management of Mirizzi syndrome is often dictated by the presence or absence of a cholecystobiliary communication.…”

mentioning

confidence: 99%

“…Current evidence still recommends open cholecystectomy for the management of Mirizzi syndrome [4,12]. Some authors advocate a laparoscopic approach for type I Mirizzi syndrome only [7,13,14]. However, other authors recommend laparoscopic surgery [15][16][17] or combined pre-operative ERCP and laparoscopic subtotal cholecystectomy [18] for the treatment of type II Mirizzi syndrome.…”

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confidence: 99%

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Laparoscopic management of type II Mirizzi syndrome

et al. 2020

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Background Mirizzi syndrome is an uncommon complication of longstanding gallstone disease. Pre-operative diagnosis is challenging, and to date, there is no consensus on the standard management for this condition. Until recently open cholecystectomy was the standard of care for type II Mirizzi syndrome (McSherry classification). The objective of this study was to assess the incidence and management of type II Mirizzi syndrome in patients with proven or suspected choledocholithiasis undergoing laparoscopic common bile duct (CBD) exploration and present our experience in the laparoscopic management of this rare condition over the last 21 years. Methods Prospective data collection of eleven cases of type II Mirizzi syndrome amongst a series of 425 laparoscopic bile duct explorations was performed between 1998 and 2019. Demographic, clinical, diagnostic, intra-operative, and postoperative data were recorded. Results The incidence of type II Mirizzi syndrome was 2.6% in 425 laparoscopic CBD explorations. All operations were completed laparoscopically with closure of the defect over a decompressed CBD (T-tube n = 3, antegrade stent n = 5, transcystic drain n = 2), and in one case a non-drained duct was closed with Endoloop. Stone clearance rate was 100% (11 cases). In two patients the transinfundibular approach was used in conjunction with holmium laser lithotripsy to enable choledochoscopy and successful stone clearance. Three patients were complicated in the post-operative period with bile leak (n = 2) and lower respiratory tract infection (n = 1). An incidental gallbladder carcinoma was found in one patient. Conclusion Laparoscopic management of type II Mirizzi syndrome is feasible and safe when performed by experienced laparoscopic foregut surgeons. Laparoscopy and choledochoscopy can be combined with novel approaches and techniques to increase the likelihood of treatment success.

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Section: Discussioncontrasting

confidence: 53%

Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Laparoscopic management of type II Mirizzi syndrome

et al. 2020

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Gallstones and Benign Biliary Disease

Dooley

Gurusamy

Davidson

2018

Sherlock's Diseases of the Liver and Biliary System

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Surgical outcome of Mirizzi syndrome: Value of endoscopic retrograde cholangiopancreatography and laparoscopic procedures

Yeh

Wang

Liu

et al. 2021

J Hepato Biliary Pancreat

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Background: Laparoscopic cholecystectomy (LC) with associated procedures and endoscopic retrograde cholangiopancreatography (ERCP) have been the standard treatments for both common and rare biliary diseases. Mirizzi syndrome (MS) is a rare and complex biliary condition. We report our experience with MS treatment and investigate the value of laparoscopic procedures and ERCP in patient management. Methods: From 2004 to 2017, 100 consecutive patients with MS were diagnosed by ERCP and underwent surgery in a referral center. Sixty patients were treated with intended LC, and 40 patients were treated with open cholecystectomy (OC). The clinical manifestations, ERCP and associated procedures, surgical procedures, and postoperative outcomes were investigated.Results: The surgical mortality rate was 1%, while the surgical morbidity rate was 15%. The patients treated with intended LC suffered from less morbidity (5%). The percentage of postoperative residual biliary stones was 32% (n = 32), and only three patients underwent re-operation (laparotomy) for stone removal. The laparotomy conversion rate in the intended LC group was 16.7% (10/60). The length of hospitalization for the patients with successful LC was significantly shorter than that for the patients with conversion and intended OC. Csendes classification was a risk factor for conversion from LC to OC (type I vs types II to V, P < .0001). Conclusions: A combination of a laparoscopic procedure and ERCP may provide therapeutic benefits for patients with MS.

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Complicated gallstone disease: diagnosis and management of Mirizzi syndrome

Abstract: MS is rare, but preoperative diagnosis or intraoperative suspicion is important. Laparoscopic cholecystectomy may be possible in selected type I cases. Open cholecystectomy is the standard of care for type II MS.

Cited by 40 publications

References 17 publications

Laparoscopic management of type II Mirizzi syndrome

Laparoscopic management of type II Mirizzi syndrome

Gallstones and Benign Biliary Disease

Surgical outcome of Mirizzi syndrome: Value of endoscopic retrograde cholangiopancreatography and laparoscopic procedures

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