Difficult gallstone illness: prognosis and administration of Mirizzi syndrome.
Surg Endosc. 2017 Could;31(5):2215-2222
Authors: Kulkarni SS, Hotta M, Sher L, Selby RR, Parekh D, Buxbaum J, Stapfer M
BACKGROUND: Mirizzi syndrome (MS) is characterised by an obstruction of the proximal bile duct as a result of extrinsic compression by both an impacted stone within the gallbladder neck or native inflammatory modifications. Though it is a uncommon syndrome in developed international locations (Zero.7-1.four %), preoperative prognosis and cautious surgical administration are important to keep away from bilio-vascular accidents and misdiagnosed malignancy.
METHODS: The aim of this research was to overview our expertise within the prognosis and administration of MS, assess the function of laparoscopy and the chance of concomitant gallbladder carcinoma. This research happened in a big county hospital which serves indigent and undocumented immigrants with out quick access to healthcare. Knowledge have been collected by way of a retrospective chart overview of 4939 sufferers that underwent cholecystectomy over 6 years. Affected person demographics, preoperative, intraoperative, postoperative information and outcomes have been analyzed.
RESULTS: MS was recognized in 60 of 4939 sufferers (1.21 %) who underwent cholecystectomy. The imply age at presentation was 47 years, and 35 sufferers have been females. The commonest symptom at presentation was stomach ache (100 %) adopted by nausea/vomiting (87 %) and jaundice (43 %). Kind I MS was recognized in 16 sufferers and 44 had sort II MS. Preoperative prognosis was achieved in 43 sufferers (71 %). Magnetic resonance cholangiopancreatography was the perfect diagnostic modality. Laparoscopic cholecystectomy was profitable in four out of 16 sufferers with sort I MS. Three sufferers (5.26 %) had simultaneous gallbladder most cancers. Total morbidity was 27 % and mortality was Zero. Clavien grade ?three issues have been seen in six sufferers (10 %). The imply size of follow-up was 2.three months (vary Zero-5) for sort I MS sufferers and 5.four months (vary Zero-46) for sort II sufferers.
CONCLUSIONS: MS is uncommon, however preoperative prognosis or intraoperative suspicion is vital. Laparoscopic cholecystectomy could also be attainable in chosen sort I circumstances. Open cholecystectomy is the usual of look after sort II MS.
PMID: 27585469 [PubMed – indexed for MEDLINE]