Diagnosis,treatment,and outcome of Mirizzi syndrome in the perioperative period of laparoscopic cholecystectomy

Objective To investigate the diagnosis,treatment,and outcome of Mirizzi syndrome in patients undergoing laparoscopic cholecystectomy( LC). Methods A retrospective analysis was performed on the clinical data of 32 patients who underwent LC in the 451 Hospital of PLA from December 2006 to December 2014 and experienced Mirizzi syndrome during the perioperative period. Intraoperative diagnosis,selection of surgical procedures,and evaluation of treatment outcome were summarized. Results Among these patients with Mirizzi syndrome,8 were diagnosed before surgery and 24 were diagnosed during LC. According to the Csendes classification,23 patients had type Ⅰ,7 had type Ⅱ,1 had type Ⅲ,and 1 had type Ⅳ Mirizzi syndrome. A total of 30 patients completed LC,and they all had type I or Ⅱ Mirizzi syndrome. One patient with type Ⅱ disease underwent LC and common bile duct exploration. Two patients with type Ⅲ or Ⅳ disease were converted to open surgery; the type Ⅲ patient underwent bile duct end- to- end anastomosis,and the type Ⅳ patient underwent choledochoenterostomy. Conclusion Mirizzi syndrome is difficult to diagnose,and ultrasonography is the preferred method of examination. A combination of magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography can improve preoperative diagnostic rate. Most cases of type Ⅰ and Ⅱ Mirizzi syndrome can be treated by LC. Open surgery should be considered for type Ⅲ and Ⅳ cases to avoid biliary tract injury.