Management of Mirizzi's syndrome in the laparoscopic era

Abstract

Background: Mirizzi's syndrome is an uncommon cause of common hepatic duct obstruction resulting from gallstone impaction in the cystic duct or gallbladder neck. The role of laparoscopic surgery in the treatment of this condition is still not well defined. This article reports six cases of Mirizzi's syndrome and comments on the management of this condition using the laparoscopic approach. Methods: A review of 878 consecutive cholecystectomies from July 1991 to July 1996 identified six cases of Mirizzi's syndrome (0.7%) that were approached laparoscopically. Results: This study involved three men and three women with mean age of 64 (range, 57-70) years. All cases were approached by laparoscopy. One case was converted because of unclear anatomy in the Calot's triangle due to dense adhesions; open cholecystectomy, exploration of the common bile duct and T-tube insertion was performed. The other five cases were successfully managed laparoscopically. Subtotal cholecystectomy was performed in two cases, and in three patients with cholecystocholedochal fistula, the defect was closed over a T tube. There was no postoperative morbidity or mortality. A follow-up period of 8 to 17 (mean, 12) months revealed no complications. Conclusions: Laparoscopic management of Mirizzi's syndrome is feasible and safe but can be technically demanding. A policy of trial dissection by an experienced laparoscopic surgeon is recommended, and if anatomy remains unclear, it is prudent to convert.