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Incidence and management of Mirizzi syndrome during laparoscopic cholecystectomy

Schäfer, M. ; Schneiter, R. ; Krähenbühl, L.

In: Surgical Endoscopy And Other Interventional Techniques, 2003, vol. 17, no. 8, p. 1186-1190

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    Title
    • Incidence and management of Mirizzi syndrome during laparoscopic cholecystectomy
    Author
    • Schäfer, M.. Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTS), University Hospital Zurich, CH-8091 Zurich, Switzerland
    • Schneiter, R.. Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTS), University Hospital Zurich, CH-8091 Zurich, Switzerland
    • Krähenbühl, L.. Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTS), University Hospital Zurich, CH-8091 Zurich, Switzerland
    Document Type
    • Postprint
    Language
    • English
    Published in
    • Surgical Endoscopy And Other Interventional Techniques, 2003, vol. 17, no. 8, p. 1186-1190. Springer-Verlag; www.springer-ny.com
    Other Version
    OAI-PMH Identifier
    • oai:doc.rero.ch:315197
    Summary
    Background: Benign extrinsic obstruction of the hepatic duct, known as "Mirizzi syndrome” (MS), is an uncommon complication of longstanding cholelithiasis. Since laparoscopic cholecystectomy (LC) replaced the open approach, Mirizzi syndrome has regained the interest of biliary surgeons. Methods: The Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTS) prospectively collected the data on 13,023 patients undergoing LC between 1995 and 1999. This database was investigated with special regard to patients with Mirizzi syndrome. Results: There were 39 patients (14 men and 25 women; mean age, 61 years) with MS (incidence, 0.3%). Thirty-four patients had type 1 MS and five had type 2. A gallbladder carcinoma was found in four patients (incidence, 11%). In the type 1 group, 23 patients underwent cholecystectomy only, 10 patients had a bile duct exploration and T-tube insertion, and one patient had a Roux-en-Y reconstruction. In three patients with type 2, a hepaticojejunostomy was performed; two others underwent simple closure and drainage (via T-tube) of the biliary fistula. The conversion rate was 74% (24 of 34 patients) in the type 1 group and 100% (five of five patients) for type 2. The overall complication rate was 18%. There were no deaths. Conclusions: Although MS is rarely encountered during LC, it must be recognized intraoperatively. Conversion to an open approach is often needed, and prior to any surgical intervention, gallbladder cancer must be excluded