• Mirizzi syndrome
• cholelithiasis
• laparoscopic cholecystectomy
• laparoscopic procedures

• acute calculus cholecystitis
• bile duct injury
• indocyanine green
• laparoscopic cholecystectomy
• mirizzi syndrome
• near-infrared fluorescence cholangiography

• cystic duct fibrosis
• hydrops gallbladder
• laparoscopic cholecystectomy
• magnetic resonance cholangiopancreatography
• mirizzi syndrome
• obstructive jaundice

• Mirizzi syndrome
• bile duct injury
• cholecystectomy
• choledocholithiasis
• cholelithiasis
• laparoscopic
• subtotal cholecystectomy

• Humans
• Mirizzi Syndrome/diagnosis
• Mirizzi Syndrome/surgery
• Mirizzi Syndrome/complications
• Gallstones/complications
• Fistula/complications
• Fistula/surgery
• Cholecystectomy
• Cholecystectomy, Laparoscopic

• Alagille syndrome
• Biliary atresia
• Cholecystojejunostomy
• Cholelithiasis
• Gallstone
• Mirizzi syndrome

• Bilioenteric fistula
• Cholecystobiliary fistula
• Conversion rate
• Gallstone ileus
• Laparoscopic approach
• Mirizzi’s syndrome

• Biliary Fistula/etiology
• Biliary Fistula/surgery
• Cholecystectomy, Laparoscopic/adverse effects
• Choledocholithiasis/complications
• Choledocholithiasis/surgery
• Humans
• Laparoscopy/adverse effects
• Retrospective Studies

Mirizzi syndrome (MS) remains a challenging biliary disease, and its low rate of preoperative diagnosis should be resolved. Moreover, technological advances have not resulted in decisive improvements in the surgical treatment of MS. Complex bile duct lesions due to MS make surgery difficult, especially when the laparoscopic approach is adopted. The safety and long-term effect of MS treatment need to be guaranteed in terms of preoperative diagnosis and surgical strategy.

To analyze preoperative diagnostic methods and the safety, effectiveness, prognosis and related factors of surgical strategies for different types of MS.

The clinical data of MS patients who received surgical treatment from January 1, 2010 to December 31, 2020 were retrospectively reviewed. Patients with malignancies, choledochojejunal fistula, lack of data and lost to follow-up were excluded. According to preoperative imaging examination records and documented intraoperative findings, the clinical types of MS were determined using the Csendes classification. The safety, effectiveness and long-term prognosis of surgical treatment in different types of MS, and their interactions with the clinical characteristics of patients were summarized.

Sixty-six patients with MS were included (34 males and 32 females). Magnetic resonance imaging/magnetic resonance cholangiopancreatography (MRI/MRCP) showed specific imaging features of MS in 58 cases (87.9%), which was superior to ultrasound scan (USS) in the diagnosis of MS and more sensitive to subtle biliary lesions than USS. The overall laparoscopic surgery completion rate was 53.03% (35/66), where the completion rates of MS type I, II and III were 69.05% (29/42), 42.86% (6/14) and zero (0/10), respectively. Thirty-one patients (46.97%) underwent laparotomy or conversion to laparotomy including 11 cases of iatrogenic bile duct injury which occurred in type I patients, and 25 of these patients underwent bile duct exploration, repair and T-tube drainage. In addition, 25 patients underwent intraoperative choledochoscopy and T-tube cholangiography. Overall, 21 cases (31.8%) were repaired by simple suturing, and 14 cases (21.2%) were repaired using the remaining gallbladder wall patch in the subtotal cholecystectomy. The ascendant of the Csendes classification types led to an increase in surgical complexity reflected by increased operation time, bleeding volume and cost. Gender, acute abdominal pain and measurable stone size had no effect on Csendes type of MS or final surgical approach. Age had no effect on the classification of MS, but it influenced the final surgical approach, hospital stay and cost. A total of 66 patients obtained a relatively high preoperative diagnostic rate and underwent surgery safely without serious complications, and no mortality was observed during the follow-up period of 36.5 ± 26.5 mo (range 13-76, median 22 mo).

MRI/MRCP can improve the preoperative diagnosis of MS. The Csendes classification can reflect the difficulty of treatment. The surgical strategies including laparoscopic surgery for MS should be formulated based on full evaluation and selection.

• Mirizzi syndrome
• Surgical strategy
• Diagnosis
• Classification
• Surgical approach
• Laparoscope

Mirizzi syndrome occurs in up to 6% of patients with cholecystolithiasis. It is generally caused by external compression of the common hepatic duct by a gallstone impacted in the neck of the gallbladder or the cystic duct, which can lead to fistulisation. The aim of this review was to highlight the proposed classifications for Mirizzi syndrome (MS) and to provide an update on modern approaches to the diagnosis of this disease. We conducted research on various internet databases and the total number of records was 993, but after a gradual process of elimination our final review consisted of 21 articles. According to the literature, the Cesendes classification is the most commonly used, but many new suggestions have appeared. Our review shows that the ultrasonography (US) is the most frequently used method of initial diagnosis, despite still having only average sensitivity. Magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) are good methods and are similarly effective, but only the latter can be simultaneously therapeutic. Some modern methods show very high sensitivity, but are not so commonly administered. Mirizzi syndrome is still a diagnostic challenge, despite the advancement of the available tools. Preoperative diagnosis is crucial to avoid complications during treatment. New research may bring a unification of classifications and diagnostic algorithms.

• cholecystobiliary fistula
• classification
• computed tomography (CT)
• endoscopic retrograde cholangiopancreatography (ERCP)
• magnetic resonance cholangiopancreatography (MRCP)
• preoperative diagnosis
• ultrasonography (US)

• Endoscopy
• Laparoscopic cholecystectomy
• Laparoscopy
• Mirizzi syndrome
• Review

• Cholecystectomy, Laparoscopic/methods
• Disease Management
• Feasibility Studies
• Humans
• Mirizzi Syndrome/diagnosis
• Mirizzi Syndrome/surgery

•

Mirizzi syndrome is a rare entity.

Mirizzi’s syndrome is a rare but potential complication of long standing gallstone disease, particularly cholecystolithiasis.

Being described is a case of a 42 year old patient who presented with right upper quadrant pain. Initially sent home as the pain settled but was diagnosed as Mirrizi’s syndrome on readmission and was managed accordingly. This case report is being presented with the aim of highlighting the importance of Mirizzi’s syndrome and the potential consequences it may bear.

Due to lack of symptom specificity, this entity remains undiagnosed preoperatively in majority of the cases. Although safe in expert hands, minimally invasive approach (in selected types) can be challenging and bears the risk of bile duct injuries, with a high probability of conversion.

Delays in targeted management may lead to dire consequences ranging from empyema gallbladder to gangrene of gall bladder wall, perforation and frank sepsis. A thorough clinical history and physical examination and assessment in light of clinical investigations can lead to a timely diagnosis and management.

• Cholecystolithiasis
• Choledocho-colic fistula
• Gallbladder empyema
• Mirizzi’s syndrome

• Cholecystocholedochal fistula
• LABEL
• Laparoscopy
• Mirizzi syndrome
• Transinfundibular approach
• Type II Mirizzi

• Adult
• Aged
• Aged, 80 and over
• Biliary Tract Surgical Procedures
• Cholecystectomy, Laparoscopic/methods
• Choledocholithiasis/complications
• Choledocholithiasis/epidemiology
• Choledocholithiasis/surgery
• Female
• Gallbladder Neoplasms/diagnosis
• Gallbladder Neoplasms/surgery
• Humans
• Lasers, Solid-State
• Lithotripsy, Laser/methods
• Male
• Middle Aged
• Mirizzi Syndrome/diagnosis
• Mirizzi Syndrome/epidemiology
• Mirizzi Syndrome/surgery
• Prospective Studies
• Treatment Outcome

Mirizzi syndrome, also known as extrinsic biliary compression syndrome, is a rare clinical entity in which the common bile duct is obstructed by compression by the impaction of one or more gallstones in the cystic duct or gallbladder infundibulum. This case illustrates an absolutely asymptomatic presentation of Mirizzi syndrome in a 62-year-old, otherwise healthy, woman. Mirizzi syndrome was treated with preemptive laparotomy cholecystectomy. The present case is exemplary for careful evaluation with the proper index of suspicion in establishment of preoperative diagnosis as well as prompt treatment prior to development of complications.

• cholecystectomy
• gallstone
• mirizzi syndrome