MIRIZZI'S SYNDROME

Abstract

Mirizzi's syndrome is a rare complication of long-standing gallstone disease. The aim of this retrospective study was to evaluate our patients with Mirizzi's syndrome, according to their presentation, work up, operative findings, choice of operative repair, complications and long-term follow up results. Between September 1997 and June 2003, a total number of 1620 patients were operated for biliary tract diseases at our clinic and from this patient population, 24 patients (1,5% ) were considered to have Mirizzi's syndrome. Among them, 9 (37% ) had a Type 1 lesion and 15 (63%) a Type 2 lesion. The correct preoperative diagnosis could be done only in 3 (12%) patients. Open surgery was the choice of treatment in all cases in which two of them were operated laparoscopically at the beginning but converted to open surgery due to intensive adhesions around Calot triangle and acquired abnormalities of the biliary tract. Cholecystectomy was done in patients with Type 1 lesions and different operative strategies including, primary common bile duct repair with gallbladder flap, T-tube drainage, choledochoduodenostomy or Roux- en-Y hepaticojejnostomy were done in type 2 lesions according to intraoperative findings. The coexistence rate of gallbladder carcinoma was 4%. Also the mortality was seen in the same patient due to external biliary fistula. There was no complication due to benign biliary stricture during follow up period of mean 42 months. As a conclusion, Mirizzi's syndrome must be considered in differential diagnosis of patients with obstructive jaundice. Eventhough there are many advances in radiological and endoscopic diagnostic modalities, Mirizzi's syndrome has still a complex challenge for surgeons regarding its clinical behaviour, diagnosis and surgical treatment.