Vanishing Calot Syndrome: Pseudo-Mirizzi Syndrome

Mercado, Miguel Ángel; Leon, Alexandra Rueda de; Cisneros-Correa, J.

doi:10.1016/j.jamcollsurg.2020.01.036

Cited by 4 publications

(1 citation statement)

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“…In our view the routine use of subtotal cholecystectomy can lead to over-classifying cases as MS when in fact they had simpler impacted Hartman pouch or cystic duct stones. This “Pseudo-Mirizzi Syndrome” was suggested by Mercado et al as a possible cause of over-diagnosis of MS and of attributing bile duct injury to a Mirizzi abnormality [ 15 ]. This occurrence will be more frequent if the surgeon does not perform cholangiography or choledochoscopy and may lead to retained CBD stones.…”

Section: Discussionmentioning

confidence: 99%

One-session laparoscopic management of Mirizzi syndrome: feasible and safe in specialist units

Nassar

Gil

et al. 2020

Surg Endosc

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Background To evaluate the laparoscopic management of Mirizzi syndrome, seldom diagnosed preoperatively causing difficulty when performing cholecystectomy and increasing complication risks. Methods Analysis of a prospective single-surgeon database of 5700 laparoscopic cholecystectomies found 58 Mirizzi syndrome cases. They were managed with an intention to treat during the index admission according to protocol of singlesession management of bile duct stones. Results 38/58 patients were females (65.5%). The median age was 55 years. 53 cases were emergency admissions. 34 cases (58.6%) only had ultrasound scanning. Operative difficulty was Grade IV in 34 cases (58.6%) and Grade V in 20 (34.5%) (Nassar Scale). There were 33 Mirizzi Type IA, 7 Type IB, 16 Type II and one each of Type III and Type IV. Bile duct exploration was performed in 94.8% through choledochotomy/ transfistula in 58.6% or transcystic in 36.2%. Four cases required conversion to open. Postoperative morbidity occurred in 29%. Two 30-day mortalities occurred from pneumonia in two elderly patients who were late referrals. Conclusion Although the utilization of the laparoscopic approach in managing bile duct stones is not currently widely practiced it was safer in this series than in reported series of open surgery in Mirizzi Syndrome. The optimal approach to Mirizzi Type II is via cholecystocholedochal fistula to explore the bile duct then drain with T-tube through the fistula. It is unnecessary to perform bilioenteric bypass in majority of cases, reducing the morbidity and mortality.

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Section: Discussionmentioning

confidence: 99%