Mirizzi Syndrome: An Experience in Laparoscopic Era

Abstract

Objective: To assess the presentation and surgical management of Mirrizi syndrome patients who underwent Laparoscopic Cholecystectomy. Study Design and Setting: Retrospective Descriptive Study was conducted at Surgical Department Combined Military Hospital Rawalpindi and Combined Military Hospital Quetta from 1st Jan 2010 to 20th Jan 2016. Methodology: Patients undergoing laparoscopic cholecystectomy during this period were retrospectively reviewed. All cases of Mirizzi Syndrome (MS) were identified and data analysed. Results: A total of 5500 patients underwent laparoscopic cholecystectomy during this period. Approximately 26(0.47%) cases were identified to be having MS. Out of these 26 cases only 8 (30%) were males while 18 (70%) were females. Age ranged from 25 to 80 years. Three patients (11%) had an endoscopic retrograde cholangiopancreaticography (ERCP) done. Type-I MS was found in 19 cases (73 %), Type-II in 3 cases (11%), Type-III and Type-IV in 2 cases each (7.69 %). Conversion to open surgery was carried out in 15 cases (57.6 %). All type-I MS had cholecystectomy except one case where partial cholecystectomy was done. T-tube closure of common bile duct was done in all Type-II MS. Similarly T tube closure was possible in two cases of type-III while one had Roux-en-Y hepaticojejunostomy. All cases of type-IV MS had Roux-en-Y hepaticojejunostomy. One patient out of 26 (3.8 %) had carcinoma gallbladder. There was no mortality. Conclusion: Type-I MS can be managed with laparoscopic cholecystectomy in selected patients.Type-II and type-III MS may need placement of T-tube while most of type-IV MS are managed with Roux-en-Y hepaticojejunostomy.