Minimally invasive surgery in the management of Mirizzi syndrome

Abstract An impacted gallstone in the cystic duct or in the Hartman's pouch with subsequent inflammation and edema resulting in extrinsic compression of the common hepatic or common bile duct with obstructive jaundice is known as Mirizzi's syndrome. The Mirizzi syndrome presents a difficult surgical challenge because of the dense adhesions and edematous inflammatory tissue cause distortion of the normal anatomy in Calot's triangle, leading to a great risk of bile duct injury. Therefore, a controversial issue the surgical strategy for the treatment of Mirizzi's syndrome since the introduction of laparoscopic cholecystectomy. The present study was undertaken to elucidate the applicability of microlaparotomy cholecystectomy in the management of Mirizzi's syndrome. Between December 1990 and December 1996 we operated on 16 patients for Mirizzi's syndrome. In 14 of these patients had type I of Mirizzi's syndrome, the remaining 2 had type II of this syndrome. In 13 of these patients the gallbladder were removed using 3-4 cm single microlaparotomy incisions. In the remaining 3 patients using 5.5 cm, 8 cm as well as 12 cm long incisions for the removal of the gallbladder, and placement T tube because of stenosis of the common hepatic duct, suture repair of the choledochal defect as well as choledochoplasty. In 12 of these patients the microlaparotomy cholecystectomy were done within 7 days of the onset of the obstructive cholecystitis. The postoperative stay of these patients were uneventful and they were discharged home 3 days after surgery. We conclude that early operation of the obstructive cholecystitis with Mirizzi's syndrome eliminates the serious stricture and fistula formation of Mirizzi's syndrome.