The Mirizzi Syndrome - A contraindication for laparoscopic surgery Academic Article uri icon

Overview

MeSH Major

  • Cholecystectomy, Laparoscopic
  • Cholelithiasis
  • Cholestasis, Extrahepatic
  • Cystic Duct
  • Hepatic Duct, Common

abstract

  • The Mirizzi syndrome refers to a benign obstruction of the common hepatic duct by a stone impacted within the cystic duct or the neck of the gallbladder causing an obstructive jaundice. According to McSherry's subclassification based on endoscopic retrograde cholangio-pancreatography we distinguish a type I, involving an external compression of the common hepatic duct by a large stone impacted in the cystic duct or Hartmann's pouch without lesion of the gallbladder or the common hepatic duct wall. In type II a cholecysto-choledochal fistula is present, caused by a calculous which has already eroded partly or completely into the common bile duct. The type I is better treated with a partial cholecystectomy, the type II with a partial cholecystectomy and a bilio-digestive anastomosis. Due to a severe inflammatory process with dense adhesions and odematous changes of the hepato-duodenal ligament, it is dangerous to prepare the Calot's triangle, in case of conventional cholecystectomy and/or in case of laparoscopic cholecystectomy. From 1986-1991 we have successfully treated 10 patients according to this concept (7 patients with type II, 3 patients with type I). We have no mortality and no lesion of the biliary system. One patient has been reoperated because of a postoperative hemorrhage and biliary fistula. One patient developed a benign stricture which could be dilated two months after the procedure. Two patients were found with an incidental carcinoma of the gallbladder.

publication date

  • January 1993

Research

keywords

  • Academic Article

Identity

Language

  • fre

PubMed ID

  • 8473173

Additional Document Info

start page

  • 577

end page

  • 80

volume

  • 59

number

  • 4