Appraisal of diagnosis and surgical approach for Mirizzi syndrome.

BACKGROUND: Mirizzi syndrome is an important and rare complication of gallstone disease. This study aims to evaluate the treatment approach by analysing the diagnostic method and the outcome of surgical treatment in our hospital.

METHODS: We retrospectively analysed the data of 198 patients with Mirizzi syndrome between January 2004 and January 2010. The records were reviewed for demography, clinical presentation, diagnostic method, operative procedure, postoperative complication and follow-up.

RESULTS: The incidence of Mirizzi syndrome was 0.66% of 29 875 patients who underwent cholecystectomy for cholelithiasis. The incidence of types I, II, III and IV was 59.1%, 24.7%, 13.1% and 3.1%, respectively. In this study, ultrasonography and magnetic resonance cholangiopancreatography (MRCP) could have the suspicion of Mirizzi syndrome in 77.8% and 82.3% of cases. Cholecystectomy also has been shown to be effective for type I Mirizzi syndrome. Our common surgical approach in Mirizzi syndrome types II and III was partial cholecystectomy without removal of the portion of gallbladder around the fistula margin. For some cases, choledochoplasty was needed. For Mirizzi syndrome type IV, we performed hepaticojejunostomy for all patients.

CONCLUSION: Ultrasound, MRCP and endoscopic retrograde cholangiopancreatography in combination with choledochoscope procedure in operation could improve the diagnostic sensitivity of Mirizzi syndrome. Intraoperative choledochoscope is effective to confirm Mirizzi syndrome during operation. Open surgery is the current standard for managing patients with Mirizzi syndrome. Laparoscopic surgery should be confined to Mirizzi syndrome type I and patients should be selected very strictly.