Clinical Analysis Of 53 Cases With Mirizzi Syndrome

Backgrounds and Objective: Mirizzi Syndrome is a rare and challenging clinical entity to manage.However,recent advances in technology have provided surgeons with new options for more effective diagnosis and treatment of this condition.Methods: This retrospective study identifed patients operated for MS between January 2013 and December 2017 and recorded and analysed their pre-operative demographics,pre-operative diagnostic strategies,operative management,and outcome.Results:The incidence of MS was 0.54% in 9906 cholecystectomies for cholelithiasis.There were 25 men and 28 women,with a mean age of 55.8 years.33 patients had MS type I(63.3%).27 were treated with laparoscopic cholecystectomy(LC)successfully,whereas 3 conversions were performed because of difficult surgical dissection.In the remaining 3,cholecystectomy was performed.12 patients had type II MS(22.6%).In 10 cases cholecystectomy and bile duct repair were performed with T-tube placement,in another two LC and Choledocholithotomy with T-tube placement was performed.Five patients had type III MS(9.4%).In three cases cholecystectomy and bile duct repair were performed with T-tube placement.Another2 case and the remaining patients with type IV MS(5.4%)were treated with Roux-en-Y hepaticojejunostomy.The laparoscopic cohort had a shorter length of hospital stay when compared to the entire group.Conclusion:As yet,there are no internationally-accepted guidelines for the management of Mirizzi Syndrome.The majority of cases are not identified pre-operatively,despite the availability of modern imaging techniques.Laparotomy is the current standard for managing patients with Mirizzi syndrome.LC is feasible for Type I,but can be selectively applied to Type II.This pathology should be treated by experienced surgeons.