Preoperative diagnosis and efficacy of laparoscopic procedures in the treatment of Mirizzi syndrome.

Abstract

The role of laparoscopic procedures in the treatment of Mirizzi syndrome (MS) is not well-defined and remains controversial. We evaluated the preoperative diagnosis and efficacy of laparoscopic procedures in treatment of MS. Preoperative diagnosis and cholecystectomy were attempted on 2,012 consecutive patients at a single center and 24 (1.2%) were finally diagnosed with MS. Patients without preoperative endoscopic retrograde cholangiography underwent preoperative spiral CT after IV infusion cholangiography (IVC-SCT). Fourteen patients had McSherry type I MS (MS I) and 10 had type II MS (MS II). Open operation was performed on patients with MS II or a preoperative suspicion of gallbladder cancer. Laparoscopic cholecystectomy (LC) was performed successfully on 10 of 14 patients with MS I and the remaining 4 patients with MS I were converted to open procedure. At preoperative endoscopic retrograde cholangiography (n = 3) or IVC-SCT (n = 11) on patients with MS I, 3 of 4 (75%) patients who were converted to open operation had a nonvisualized cystic duct, and 9 of 10 (90%) patients with LC had a visualized cystic duct. MS I with a visualized cystic duct can be considered to be an indication for laparoscopic operation. IVC-SCT can be a useful tool for correct preoperative diagnosis and assessment of the feasibility of LC in patients with MS I.