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.
2. Syplyviy V, Ievtushenko D, Petrenko G, Ievtushenko A. Surgical management of patients with Mirizzi syndrome. HPB [Internet]. 2016;18:e674–e675. doi: 10.1016/j.hpb.2016.01.033. Available from: https://www.hpbonline.org/article/S1365–182X(16)00103–9/fulltext.
3. Xu XQ, Hong T, Li BL, Liu W, He XD, Zheng CJ. Mirizzi syndrome: our experience with 27 cases in PUMC Hospital. Chin Med Sci J 2013;28:172–7. 10.1016/S1001–9294(13)60044–9.
4. Roesch-Dietlen F1, Perez-Morales AG, Martinez-Fernandez S, Remes-Troche JM, Jimenez-Garcia VA, Romero-Sierra G. Mirizzi syndrome: experience at Spanish Hospital of Veracruz. Cir Cir 2013;81:232–6. PMID: 23769254. [In Spanish].
5. Gibor U, Perry ZH, Netz U, et al. CA 19–9 in the presence of obstructive jaundice due to Mirizzi syndrome. Isr Med Assoc J. 2015;17:60–1. PMID: 25739181.
6. Li B, Li X, Zhou WC, He MY, Meng WB, Zhang L, Li YM. Effect of endoscopic retrograde cholangiopancreatography combined with laparoscopy and choledochoscopy on the treatment of Mirizzi syndrome. Chin Med J (Engl). 2013;126:3515–8. PMID: 24034100.
7. Rayapudi K, Gholami P, Olyaee M. Mirizzi syndrome with endoscopic ultrasound image. Case Rep Gastroenterol. 2013;7:202–7. doi:10.1159/000351170.
8. Tsuyuguchi T, Sakai Y, Sugiyama H, et al. Long–term follow–up after peroral cholangioscopy–directed lithotripsy in patients with difficult bile duct stones, including Mirizzi syndrome: an analysis of risk factors predicting stone recurrence. Surg Endosc. 2011;25:2179–85. doi:10.1007/s00464–010–1520–1.
9. Stagnitti F. Biliodigestive fistulae and gallstoneileus: diagnostic and therapeutic considerations. Our experience. Giornale di Chirurgia – Journal of Surgery. 2014
Available from: https://www.giornalechirurgia.it/common/php/portiere.php?ID=3e861b3e970c0dc6715ca63073d93498. doi: 10.11138/gchir/2014.35.9.235.
10. Valderrama–Trevino AI, Granados–Romero JJ, Espejel–Deloiza M, et al. Updates in Mirizzi syndrome. Hepatobiliary Surg Nutr. 2017;6(3):170–8. doi:10.21037/hbsn.2016.11.01.
11. Dutka Y, Chooklin S. The special features of surgical treatment of patients with the Mirizzi syndrome. HPB. 2016;18:e820. Available from: https://www.hpbonline.org/article/S1365–182X(16)00459–7/fulltext doi: 10.1016/j.hpb.2016.01.389.
12. Artyushenko M, Tumak І, Kogut L. Bіlіodigestivnі noricі і neprohіdnіst’ kishkіvnika, sprichinena zhovchevimi kamenyami, v prakticі urgentnoї endoskopії: oglyad lіteraturi і vlasnij dosvіd. Ukraїns’kij zhurnal maloinvazivnoї ta endoskopichnoї hirurgiї. 2012;16(2):20–2. [In Unkrain].
13. Oter V. Surgical outcomes of Mirizzi syndrome: a single institution’s experience of 34 cases. Laparoscopic Endoscopic Surgical Science. 2017 Availablefrom: http://www.lapend.org/jvi.aspx?un=LESS–79664. doi: 10.14744/less.2017.79664.
14. Zaporozhchenko B, Bondarets D, Borodaev I, Kachanov V, Muravyov P, Zubkov O et al. Modern diagnostic methods and approaches to the surgical treatment of Mirizzi syndrome. Ukrainian journal of surgery. 2018;0(4.35):33–7. Availablefrom: http://ujs.zaslavsky.com.ua/article/view/118890. doi: 10.22141/1997–2918.104.22.1687.118890.
15. Lee KF. Mirizzi syndrome: a new approach to an old problem. Hepatobiliary Surg Nutr. 2018;7(1):56–7. doi:10.21037/hbsn.2017.12.09.
This work is licensed under a Creative Commons Attribution 4.0 International License.