Safety and feasibility of laparoscopic approaches for the management of Mirizzi syndrome: a systematic review
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and Other Interventional Techniques
REVIEW ARTICLE
Safety and feasibility of laparoscopic approaches for the management of Mirizzi syndrome: a systematic review Jiannan Zhao1 · Ying Fan1 · Shuodong Wu1 Received: 26 February 2020 / Accepted: 2 July 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Laparoscopic approaches for the management of Mirizzi syndrome (MS) are controversial and challenging procedures for high conversion rate. This review aims at evaluating their safety and feasibility. Methods We reviewed studies related to the laparoscopic approaches for the management of MS with detailed data of articles from January 2009 to December 2019 found in PubMed. Results From 63 articles, we reviewed 17 articles detailing laparoscopic approaches for MS. There were 857 patients with MS; 432 of which were identified from 73,842 patients underwent cholecystectomy. Laparoscopic approaches were attempted in 440 patients and were successful in 290. The conversion rate was 34.09%. Various methods including laparoscopic cholecystectomy, laparoscopic subtotal cholecystectomy, laparoscopic common bile duct exploration (LCBDE) and (LTCBDE) were performed. The preoperative diagnosis of MS was made in 338 of 500 patients (67.60%). The mean operating time ranged from 49.7 ± 27.5 min to 270.5 ± 65.5 min, and the mean intraoperative bleeding varied from 21.1 ± 15.9 ml to 162.81 ± 40.83 ml. The mean hospital stay varied from 4.5 ± 3.7 to 7.21 ± 1.61 days. Postoperative complications occurred in 27 patients. Conclusions Various laparoscopic approaches are safe and feasible for the treatment of MS in the hands of experienced laparoscopic surgeons, especially for type I and II of Csendes classification. Definitive preoperative diagnosis and earlier management are essential. Keywords Mirizzi syndrome · Laparoscopy · Laparoscopic cholecystectomy · Endoscopy · Review Mirizzi syndrome (MS) is a rare complication of cholecystolithiasis caused by compression of the common hepatic duct (CHD) by stones in the cystic duct or Hartmann’s pouch of the gallbladder. Kehr [1] described this condition in 1905 for the first time. Ruge [2] described it in 1908, and Pablo Mirizzi [3] named it “Mirizzi syndrome’’ in 1948. The incidence of MS is 0.06–5.7% in cholecystectomies [4]. The variants of MS have been classified by McSherry [5], Csendes [6] and Beltràn [7]; the latter was proposed in 2012 without wide adoption. According to the presence of cholecystobiliary fistula or not, McSherry et al. classified MS into two types (type I and type II), and then Csendes et al. subclassified type II into four types as listed in Table 1 with illustrations [6, 8]. * Ying Fan [email protected] 1
Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
MS usually presents with obstructive jaundice, acute cholecystitis, acute cholangitis and which were similar to that of obstructive CBD (common bile duct) stone. When a patient is suspicious of MS, ultrasonography, com
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