Mirizzi Syndrome: Experience In Diagnosis And Treatment Of25Cases

Object: To summarize the experience in diagnosis and treatment ofMirizzi syndrome (MS), and reduce the incidence of operativecomplications.Methods: Twenty five cases of Mirizzi syndrome from2005Jan. to2010Jan. were retrospectively analyzed.Results: There were11male patients and14female patients, rangingin ages from26to80years with a median age of51.3. Preoperativeradiological diagnosis was achieved in ten patients: ultrasonography(n=five), magnetic resonance cholangiopancreatography (MRCP)(n=ten).The others were diagnosed intraoperatively. Fifteen patients had Type I MS,two were treated with laparoscopic cholecystectomy successfully,laparoscopic procedure had to be converted to open procedure in onepatient, seven had open complete cholecystectomy, three had subtotalcholecystectomy and two had removal stones from the gallbladder andcholedochostomy after cholecystotomy were performed firstly, andsecondary cholecystectomy was operated three months later. Six patientshad Type II MS, five underwent cholecystectomy, common bile duct (CBD) repair and T-tube insertion, one was managed with transection of CBD andRoux-en-Y hepaticojejunostomy. Two patients of Type III MS underwentcholecystectomy, CBD repair and T-tube insertion. Cholecystectomy andRoux-en-Y hepaticojejunostomy was performed in the two patients of TypeIV MS. All the patients recovered from the operation. The follow-up periodranged from five years to five months. One patient developed obstructivejaundice more than two years after the operation, and recovered after thesecondary operation. The follow-up of others were uneventful.Conclusion: Preoperative diagnosis of MS is every difficult, MRCP isvery helpful in preoperative diagnosis, and a high index of clinicalsuspicion is required to make a preoperative or intraoperative diagnosis,which can lead to correct operative strategy to manage Mirizzi syndrome.