Mirizzi syndrome: History, current knowledge and proposal of a simplified classification

Table 4 New proposed classification and suggested surgical treatment for Mirizzi syndrome

Type of Mirizzi	Description	Treatment
I	External compression of the bile duct	Open cholecystectomy
		Open subtotal cholecystectomy
		Laparoscopic cholecystectomy
		Laparoscopic subtotal cholecystectomy
IIa	Cholecystobiliary fistula < 50% the diameter of the bile duct	Open cholecystectomy
		Open subtotal cholecystectomy
IIb	Cholecystobiliary fistula > 50% the diameter of the bile duct	Open subtotal cholecystectomy
		Biliary-enteric derivation:
		Side-to-side to the duodenum
		En-Y-de-Roux to the Jejunum
IIIa	Cholecystobiliary fistula and cholecystoenteric fistula without gallstone ileus	Simple closure of the fistula and treatment of the gallbladder according to the presence of Mirizzi I, IIa or IIb
IIIb	Cholecystobiliary fistula and cholecystoenteric fistula with gallstone ileus	Treatment of the gallstone ileus and deferred treatment of the gallbladder according to the presence of Mirizzi I, IIa or IIb