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Laparoscopic approach is safe and effective in the management of Mirizzi syndrome
CONTEXT: Mirizzi syndrome (MS), an unusual complication of gallstone disease is due to mechanical obstruction of the common hepatic duct and is associated with clinical presentation of obstructive jaundice. Pre-operative identification of this entity is difficult and surgical management constitutes...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Medknow Publications & Media Pvt Ltd
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4640023/ https://www.ncbi.nlm.nih.gov/pubmed/26622114 http://dx.doi.org/10.4103/0972-9941.140216 |
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author | Kamalesh, Naduthottam Palaniswami Prakash, Kurumboor Pramil, Kaniyarakal George, Thaliyachira Deepak Sylesh, Aikot Shaji, Ponnambathayil |
author_facet | Kamalesh, Naduthottam Palaniswami Prakash, Kurumboor Pramil, Kaniyarakal George, Thaliyachira Deepak Sylesh, Aikot Shaji, Ponnambathayil |
author_sort | Kamalesh, Naduthottam Palaniswami |
collection | PubMed |
description | CONTEXT: Mirizzi syndrome (MS), an unusual complication of gallstone disease is due to mechanical obstruction of the common hepatic duct and is associated with clinical presentation of obstructive jaundice. Pre-operative identification of this entity is difficult and surgical management constitutes a formidable challenge to the operating surgeon. AIM: To analyse the clinical presentation, pre-operative diagnostic strategies, operative management and outcome of patients operated for MS in a tertiary care centre. MATERIALS AND METHODS: This retrospective study identified patients operated for MS between January 2006 and August 2013 and recorded and analysed their pre-operative demographics, pre-operative diagnostic strategies, operative management, and outcome. RESULTS: A total of 20 patients was identified out of 1530 cholecystectomies performed during the study period giving an incidence of 1.4%. There were 11 males and 9 females with a mean age of 55.6 years. Abdomen pain and jaundice were predominant symptoms and alteration of liver function test was seen in 14 patients. Endoscopic retrograde cholangiopancreatography (ERCP) the mainstay of diagnosis was diagnostic of MS in 72% of patients, while the rest were identified intra-operatively. The most common type of MS was Type II with an incidence of 40%. Cholecystectomy was completed by laparoscopy in 14 patients with a conversion rate of 30%. A choledochoplasty was sufficed in most of the patients and none required a hepaticojejunostomy. The laparoscopic cohort had a shorter length of hospital stay when compared to the entire group. CONCLUSION: MS, a rare complication of cholelithiasis is a formidable diagnostic and therapeutic challenge and pre-operative ERCP as a main diagnostic strategy enables the surgeon to identify and minimize bile duct injury. A choledochoplasty might be sufficient in the majority of the types of MS, while a laparoscopic approach is feasible and safe in most cases as well. |
format | Online Article Text |
id | pubmed-4640023 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Medknow Publications & Media Pvt Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-46400232015-11-30 Laparoscopic approach is safe and effective in the management of Mirizzi syndrome Kamalesh, Naduthottam Palaniswami Prakash, Kurumboor Pramil, Kaniyarakal George, Thaliyachira Deepak Sylesh, Aikot Shaji, Ponnambathayil J Minim Access Surg Original Article CONTEXT: Mirizzi syndrome (MS), an unusual complication of gallstone disease is due to mechanical obstruction of the common hepatic duct and is associated with clinical presentation of obstructive jaundice. Pre-operative identification of this entity is difficult and surgical management constitutes a formidable challenge to the operating surgeon. AIM: To analyse the clinical presentation, pre-operative diagnostic strategies, operative management and outcome of patients operated for MS in a tertiary care centre. MATERIALS AND METHODS: This retrospective study identified patients operated for MS between January 2006 and August 2013 and recorded and analysed their pre-operative demographics, pre-operative diagnostic strategies, operative management, and outcome. RESULTS: A total of 20 patients was identified out of 1530 cholecystectomies performed during the study period giving an incidence of 1.4%. There were 11 males and 9 females with a mean age of 55.6 years. Abdomen pain and jaundice were predominant symptoms and alteration of liver function test was seen in 14 patients. Endoscopic retrograde cholangiopancreatography (ERCP) the mainstay of diagnosis was diagnostic of MS in 72% of patients, while the rest were identified intra-operatively. The most common type of MS was Type II with an incidence of 40%. Cholecystectomy was completed by laparoscopy in 14 patients with a conversion rate of 30%. A choledochoplasty was sufficed in most of the patients and none required a hepaticojejunostomy. The laparoscopic cohort had a shorter length of hospital stay when compared to the entire group. CONCLUSION: MS, a rare complication of cholelithiasis is a formidable diagnostic and therapeutic challenge and pre-operative ERCP as a main diagnostic strategy enables the surgeon to identify and minimize bile duct injury. A choledochoplasty might be sufficient in the majority of the types of MS, while a laparoscopic approach is feasible and safe in most cases as well. Medknow Publications & Media Pvt Ltd 2015 /pmc/articles/PMC4640023/ /pubmed/26622114 http://dx.doi.org/10.4103/0972-9941.140216 Text en Copyright: © 2015 Journal of Minimal Access Surgery http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. |
spellingShingle | Original Article Kamalesh, Naduthottam Palaniswami Prakash, Kurumboor Pramil, Kaniyarakal George, Thaliyachira Deepak Sylesh, Aikot Shaji, Ponnambathayil Laparoscopic approach is safe and effective in the management of Mirizzi syndrome |
title | Laparoscopic approach is safe and effective in the management of Mirizzi syndrome |
title_full | Laparoscopic approach is safe and effective in the management of Mirizzi syndrome |
title_fullStr | Laparoscopic approach is safe and effective in the management of Mirizzi syndrome |
title_full_unstemmed | Laparoscopic approach is safe and effective in the management of Mirizzi syndrome |
title_short | Laparoscopic approach is safe and effective in the management of Mirizzi syndrome |
title_sort | laparoscopic approach is safe and effective in the management of mirizzi syndrome |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4640023/ https://www.ncbi.nlm.nih.gov/pubmed/26622114 http://dx.doi.org/10.4103/0972-9941.140216 |
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