Seah WM, et al. - Researchers perform a retrospective review of the diagnostic and management challenges of Mirizzi syndrome (MS) at the Singapore general hospital. They realize that MS is a challenging condition. For its accurate pre-operative diagnosis, multimodal diagnostic approach has the greatest yield. In case of high suspicion, they recommended a trial of laparoscopic dissection with low threshold for open conversion.

Methods

• From November 2001 to June 2012, electronic records of patients surgically treated for MS were retrospectively reviewed.
• Documentation of patient presentations, diagnostic methods, treatments and complications was performed.

Results

• In accordance to a classification proposed by Beltran et al. [World J Surg 2008; 32: 2237–2243], researchers grouped 64 patients.
• They classified 43 (66.2%), 18 (27.7%) and 3 (4.6%) patients as types I, II, and III respectively.
• The most sensitive imaging modality was magnetic-resonance-cholangiopancreaticography, suggesting MS in 24 (88.9%), followed by CT scan (40%) and ultrasonography (11.4%).
• Endoscopic-retrograde-cholangiopancreaticography was performed on 44; of these 29 (65.9%) suggested the presence of MS.
• In 48 (73.8%) patients, MS was accurately diagnosed pre-operatively.
• In type I, cholecystectomy was performed on 40 (93.0%) patients, while 3 required hepaticojejunostomy.
• In type II, cholecystectomy was performed on 12 (66.7%) patients and 5 (27.8%) required hepatico-enteric anastomosis.
• In type III, 1 underwent cholecystectomy, while hepatico-enteric anastomosis was performed on 2 (66.7%).
• Laparoscopic cholecystectomy was attempted in 20 (30.8%) patients; conversion was observed in 13 (65.0%).
• In this study, 29 (44.6%) underwent intra-operative-cholangioscopy, 30 (46.2%) underwent intra-operative-cholangiogram and 41 (63.1%) underwent intra-operative T-tube placement.
• Intra-operative complications were encountered in 6 (9.2%) patients, while 12 (18.5%) experienced post-operative complications and 10 (15.4%) experienced late complications.