The methods of surgical treatment of Mirizzi’s syndrome
Objective. Determination of the surgical treatment method in treatment of spontaneous internal biliary fistulas (SIBF) in Mirizzi’s syndrome (MS).
Маterials and methods. The results of treatment of 8000 patients, suffering biliary calculous disease, in Zakarpattya Regional Clinical Hospital named after Andriy Novak in 1997 - 2017 yrs were analyzed retrospectively. In 192 of these patients SIBF was observed. Thus, the rate of the SIBF diagnosis have constituted 2.4%.
Results. In MS Type І cholecystectomy was performed with suturing of wide and short cystic duct, in the Type ІІ - cholecystectomy «from fundus» with excision of fistula and suturing of defect in common biliary duct (CBD) on a Т-like tube, in the Type ІІІ - cholecystectomy with the CBD plasty, using residuals of the gallbladder wall and external drainage with a T-like tube, and in the Type V - cholecystectomy «from fundus» with complete transsection of CBD. In 19 patients, suffering choledochoduodenal fistulas in the MS Type І, endoscopic papillofistulotomy was performed with objective to drain the CBD securely, to еvacuate the concrements from it and elimination of internal orifice of the fistula.
Conclusion. The gallbladder excision, establishing the bile drainage into the gut and unrestricted passage of the chyme along the intestine constitutes the operation objective in SIBF. While hollow organ has a fistula it is excised with the orifice suturing, in some cases the fistulas are eliminated using resectional methods.
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