Surgical outcomes of mirizzi syndrome: a single institution's experience of 34 cases

Abstract

Introduction: Mirizzi syndrome (MS) is a rare complication of cholelithiasis and surgery is the treatment of choice. It usually requires conversion to open surgery. In the present study, a retrospective assessment of experience with MS cases was performed with respect to clinical presentation, diagnostic difficulties, surgical procedures, and outcomes. Materials and Methods: Between January 2014 and June 2017, 768 patients with symptomatic cholelithiasis were operated on. Of these, 34 patients had MS. In that group, 24 patients (70.5%) were women and 10 patients (29.5%) were men. Results: The most frequent symptom was abdominal pain, seen in 33 cases (97.1%). The mean age at presentation was 65.53±13.40 years. Obstructive jaundice findings were defined with laboratory tests in 18 patients (52.9%). Surgery was performed in 30 patients (88.2%), and the median time from preoperative hospitalization to surgery was 5 days (range: 0-19 days). The distribution by type of involvment according to preoperative imaging was type I in 9 cases (26.5%), type II in 6 cases (17.6%), type III in 6 cases (17.6%), type IV in 5 cases (14.7%) and, type V in 8 cases (23.5%). Two patients were not operated on as a result of co-morbidities. Furthermore, another 2 patients who had gallstone ileus resolved with medical treatment were not operated on due to co-morbidities. Conclusion: MS is challenging for surgeons. Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography are useful for an accurate diagnosis and reducing operative complications. Laparoscopic surgery should be considered in patients with type I and in selected cases of type II MS.