Abstract
Background: Benign extrinsic obstruction of the hepatic duct, known as “Mirizzi syndrome” (MS), is an uncommon complication of longstanding cholelithiasis. Since laparoscopic cholecystectomy (LC) replaced the open approach, Mirizzi syndrome has regained the interest of biliary surgeons. Methods: The Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTS) prospectively collected the data on 13,023 patients undergoing LC between 1995 and 1999. This database was investigated with special regard to patients with Mirizzi syndrome. Results: There were 39 patients (14 men and 25 women; mean age, 61 years) with MS (incidence, 0.3%). Thirty-four patients had type 1 MS and five had type 2. A gallbladder carcinoma was found in four patients (incidence, 11%). In the type 1 group, 23 patients underwent cholecystectomy only, 10 patients had a bile duct exploration and T-tube insertion, and one patient had a Roux-en-Y reconstruction. In three patients with type 2, a hepaticojejunostomy was performed; two others underwent simple closure and drainage (via T-tube) of the biliary fistula. The conversion rate was 74% (24 of 34 patients) in the type 1 group and 100% (five of five patients) for type 2. The overall complication rate was 18%. There were no deaths. Conclusions: Although MS is rarely encountered during LC, it must be recognized intraoperatively. Conversion to an open approach is often needed, and prior to any surgical intervention, gallbladder cancer must be excluded.
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HU Baer JB Matthews WP Schweizer P Gertsch LH Blumgart (1990) ArticleTitleManagement of the Mirizzi syndrome and the surgical implications of cholecystcholedochal fistula. Br J Surg 77 743–745 Occurrence Handle1:STN:280:By%2BA2crhs1M%3D Occurrence Handle2383747
JS Bagia L North DR Hunt (2001) ArticleTitleMirizzi syndrome: an extra hazard for laparoscopic surgery. Aust N Z J Surg 71 394–397 Occurrence Handle10.1046/j.1440-1622.2001.02142.x Occurrence Handle1:STN:280:DC%2BD3MzpvV2mtA%3D%3D
CD Becker H Hassler F Terrier (1984) ArticleTitlePreoperative diagnosis of the Mirizzi syndrome: limitations of sonography and computed tomography. AJR 143 591–596 Occurrence Handle1:STN:280:BiuB2sjjt1Y%3D
TC Bower DM Nagorney (1988) ArticleTitleMirizzi syndrome. HPB Surg 1 67–74 Occurrence Handle1:STN:280:By6D1cvktVc%3D Occurrence Handle3153777
PK Chowbey A Sharma V Mann R Khullar M Baijal A Vashistha (2000) ArticleTitleThe management of Mirizzi syndrome in the laparoscopic era. Surg Laparosc Endosc Percutan Tech 10 11–14 Occurrence Handle10.1097/00019509-200002000-00003 Occurrence Handle1:STN:280:DC%2BD3cvpsVCksQ%3D%3D Occurrence Handle10872519
A Csendes JC Diaz P Burdiles F Maluenda O Nava (1989) ArticleTitleMirizzi syndrome and cholecystobiliary fistula: a unifying classification. Br J Surg 76 1139–1143 Occurrence Handle1:STN:280:By%2BD1cbpsVE%3D Occurrence Handle2597969
MJ Curet DE Rosendale S Congilosi (1994) ArticleTitleMirizzi syndrome in a Native American population. Am J Surg 168 616–621 Occurrence Handle1:STN:280:ByqD28fmsV0%3D Occurrence Handle7978006
DC Desai RD Smink Jr (1997) ArticleTitleMirizzi syndrome type II: is laparoscopic cholecystectomy justified? J Soc Laparoendosc Surg 1 237–239 Occurrence Handle1:STN:280:DyaK1M%2Fptl2mug%3D%3D
D Frauenschuh R Greim E Kraas (2000) ArticleTitleHow to proceed in patients with carcinoma detected after laparoscopic cholecystectomy. Langenbecks Arch Surg 385 495–500 Occurrence Handle10.1007/s004230000177 Occurrence Handle1:STN:280:DC%2BD3M7lsVCmsA%3D%3D Occurrence Handle11201004
D Hazzan D Golijanin P Reissman SN Adler E Shiloni (1999) ArticleTitleCombined endoscopic and surgical management of Mirizzi syndrome. Surg Endosc 13 618–620 Occurrence Handle10.1007/s004649901054 Occurrence Handle1:STN:280:DyaK1M3nvVGmsg%3D%3D Occurrence Handle10347304
LW Johnson JK Sehon WC Lee GB Zibari JC McDonald (2001) ArticleTitleMirizzi’s syndrome: experience from a multi-institutional review. Am Surg 67 11–14 Occurrence Handle1:STN:280:DC%2BD3M7is1KitA%3D%3D Occurrence Handle11206888
S Karademir H Astarcioglu S Sokmen K Atila E Tankurt H Akpinar (2000) ArticleTitleMirizzi’s syndrome: diagnostic and surgical considerations in 25 patients. J Hepatobiliary Pancreatic Surg 7 72–77 Occurrence Handle10.1007/s005340050157 Occurrence Handle1:STN:280:DC%2BD3cvntV2iug%3D%3D
TF Khan S Muniandy FZ Hayat ZA Sherazi MH Nawaz (1999) ArticleTitleMirizzi syndrome—a report of 3 cases with a review of the present classifications. Singapore Med J 40 171–173 Occurrence Handle1:STN:280:DyaK1MzjtFejug%3D%3D Occurrence Handle10402897
KY Kok PY Goh SS Ngoi (1998) ArticleTitleManagement of Mirizzi’s syndrome in the laparoscopic era. Surg Endosc 12 1242–1244
EC Lazcano-Ponce JF Miquel N Munoz R Herrero C Ferrecio II Wistuba (2001) ArticleTitleEpidemiology and molecular pathology of gallbladder cancer. CA Cancer J Clin 51 349–364 Occurrence Handle1:STN:280:DC%2BD38%2FjsVOjtw%3D%3D Occurrence Handle11760569
CK McSherry (1982) ArticleTitleThe Mirizzi syndrome: suggested classification and surgical therapy. Surg Gastroenterol 1 219–225
FH Miller GT Sica (1996) ArticleTitleMirizzi syndrome associated with gallbladder cancer and biliary-enteric fistulas. AJR 167 95–97 Occurrence Handle1:STN:280:BymB2Mfmslc%3D
P Mirizzi (1948) ArticleTitleSyndrome del conducto hepatico. J Int Chir 8 731–777
T Nagakawa T Ohta M Kayahara K Ueno I Konishi H Sanada (1997) ArticleTitleA new classification of Mirizzi syndrome from diagnostic and therapeutic viewpoints. Hepatogastroenterology 44 63–67 Occurrence Handle1:STN:280:ByiB3M7ht1c%3D Occurrence Handle9058121
A Nishimura Y Shirai K Hatakeyama (1999) ArticleTitleHigh coincidence of Mirizzi syndrome and gallbladder carcinoma. Surgery 126 587–588 Occurrence Handle1:STN:280:DyaK1Mvhs1Sluw%3D%3D Occurrence Handle10486615
H Nishio J Kamiya M Nagino K Uesaka T Sano Y Nimura (2000) ArticleTitleBiliobiliary fistula associated with gallbladder carcinoma. Br J Surg 87 1656–1657 Occurrence Handle10.1046/j.1365-2168.2000.01590.x Occurrence Handle1:STN:280:DC%2BD3M%2FnvFertg%3D%3D Occurrence Handle11122179
CG Posta (1995) ArticleTitleUnexpected Mirizzi anatomy: a major hazard to the common bile duct during laparoscopic cholecystectomy. Surg Laparosc Endosc 5 412–414 Occurrence Handle1:STN:280:BymC3cfjsVI%3D Occurrence Handle8845990
CA Redaelli MW Buchler MK Schilling L Krahenbuhl C Ruchti LH Blumgart (1997) ArticleTitleHigh coincidence of Mirizzi syndrome and gallbladder carcinoma. Surgery 121 58–63 Occurrence Handle1:STN:280:ByiC2Mvotlw%3D Occurrence Handle9001552
E Ruge (1908) ArticleTitleZur Chirurgie der grossen Gallenwege (Ductus hepaticus, choledochus und pancreaticus) Arch Clin Chir 78 47
M Sare S Gurer V Taskin M Aladag F Hilmioglu M Gurel (1998) ArticleTitleMirizzi syndrome: choice of surgical procedure in the laparoscopic era. Surg Laparosc Endosc 8 63–67 Occurrence Handle10.1097/00019509-199802000-00015 Occurrence Handle1:STN:280:DyaK1c7kslyqug%3D%3D Occurrence Handle9488574
M Schafer C Suter C Klaiber H Wehrli E Frei L Krahenbuhl (1998) ArticleTitleSpilled gallstones after laparoscopic cholecystectomy: a relevant problem? A retrospective analysis of 10,174 laparoscopic cholecystectomies. Surg Endosc 12 305–309 Occurrence Handle10.1007/s004649900659 Occurrence Handle1:STN:280:DyaK1c3hvFCitQ%3D%3D Occurrence Handle9543518
OJ Shah MA Dar MA Wani NA Wani (2001) ArticleTitleManagement of Mirizzi syndrome: new surgical approach. Aust N Z J Surg 71 423–427 Occurrence Handle10.1046/j.1440-1622.2001.02143.x Occurrence Handle1:STN:280:DC%2BD3MzpvV2lsQ%3D%3D
G Silecchia A Materia M Bezzi F Fiocca P Rosato A De Leo (1995) ArticleTitleMinimally invasive approach in Mirizzi’s syndrome. J Laparoendosc Surg 5 151–156 Occurrence Handle1:STN:280:BymD3Mfjt1Q%3D Occurrence Handle7548988
EM Targarona E Andrade C Balague J Ardid M Trias (1997) ArticleTitleMirizzi’s syndrome diagnostic and therapeutic controversies in the laparoscopic era. Surg Endosc 11 842–845 Occurrence Handle10.1007/s004649900467 Occurrence Handle1:STN:280:ByiH3M7ntFc%3D Occurrence Handle9266648
A Vezakis D Davides K Birbas BJ Ammori M Larvin MJ McMahon (2000) ArticleTitleLaparoscopic treatment of Mirizzi syndrome. Surg Laparosc Endosc Percutan Tech 10 15–18 Occurrence Handle10.1097/00019509-200002000-00004 Occurrence Handle1:STN:280:DC%2BD3cvpsVCktg%3D%3D Occurrence Handle10872520
AW Yip WC Chow J Chan KH Lam (1992) ArticleTitleMirizzi syndrome with cholecystocholedochal fistula: preoperative diagnosis and management. Surgery 111 335–338 Occurrence Handle1:STN:280:By2C2sbovVw%3D Occurrence Handle1542859
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Schäfer, M., Schneiter, R. & Krähenbühl, L. Incidence and management of Mirizzi syndrome during laparoscopic cholecystectomy . Surg Endosc 17, 1186–1190 (2003). https://doi.org/10.1007/s00464-002-8865-z
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DOI: https://doi.org/10.1007/s00464-002-8865-z