Current trends in the management of Mirizzi Syndrome

Abstract

Mirizzi Syndrome is a rare and challenging clinical entity to manage. However, recent advances in technology have provided surgeons with new options for more effective diagnosis and treatment of this condition. This paper reviews these new diagnostic modalities and treatment approaches for the management of Mirizzi Syndrome.An online search language was performed using PubMed and Web of Science for literature published in English between 2012 and 2017 using the search terms “Mirizzi Syndrome” and “Mirizzi.” In total, 16 case series and 11 case reports were identified and analyzed.The most frequently used diagnostic modalities were ultrasound, computed tomography (CT); magnetic resonance cholangiopancreaticography (MRCP); endoscopic retrograde cholangiopancreaticography (ERCP). A combination of ≥2 diagnostic modalities was frequently used to detect Mirizzi Syndrome. Literature shows that the specific type of Mirizzi Syndrome determined the type of treatment chosen. Open surgery was the preferred option, although there are documented cases of the use of minimally-invasive techniques, even in advanced cases. Laparoscopic, endoscopic or robot-assisted surgery, used individually or in combination with lithotripsy, were all associated with a favorable outcome.As yet, there are no internationally-accepted guidelines for the management of Mirizzi Syndrome. Laparotomy is the preferred surgical technique of choice, although an increasing number of surgeons are beginning to opt for minimally-invasive techniques. The number of papers in the existing literature describing diagnostic and treatment procedures is relatively small at present, thus making it difficult to reasonably propose an evidence-based standard of care for Mirizzi Syndrome.

Laparoscopic management of type II Mirizzi syndrome

“…CT scan is useful in differentiating Mirizzi syndrome from a malignancy, especially when a cholecystobiliary fistula is present [14]. Pre-operative diagnosis improves outcomes of surgery, allowing better planning [5,6,8,[27][28][29] and referral to the appropriate surgeon. If pre-operative diagnosis is not achieved, intra-operative recognition and proper management are essential to improve outcomes, reduce morbidity (up to 17% bile duct injury) and mortality [5,13].…”

Biliary Anastomotic Stricture after Surgical Management of Mirizzi Syndrome: Treated with Long-term Percutaneous Transhepatic Biliary Drainage

“…2 MS is classified according to external compression on CBD (type I), presence of cholecystobiliary fistula (type II-IV), and formation of cholecystoenteric fistula (type V). 3 Surgical treatment is mainstay for MS and various surgical procedures were suggested depending on the classification type of MS. [4][5][6] However, surgical treatment is sometimes challenging due to missed preoperative diagnosis, distortion of the anatomy of biliary tract and fistula formation caused Korean J Pancreas Biliary Tract 2018;23(3):134-138 by longstanding inflammation, and risk of bile duct injury. 4 This report describes a case of a patient with biliary anastomotic stricture after surgical management of MS, who was successfully treated with long-term percutaneous transhepatic biliary drainage (PTBD).…”

Особливості Діагностики Та Лікування Хворих На Синдром Міріззі

“…Одной из причин развития механической желтухи является синдром Мириззи. Известно, что при первом типе происходит сдавление гепатикохоледоха крупным конкрементом, фиксированным в стенке желчного пузыря, а при втором типе синдрома Мириззи формируется фистула между просветом желчного пузыря и холедохом, через который камни попадают в просвет холедоха, перекрывая частично или полностью пассаж желчи [6].…”