Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy, Laparoscopic ; Common Bile Duct ; Humans ; Mirizzi Syndrome/surgery*

OBJECTIVETo retrospectively evaluate the diagnosis and treatment of Mirizzi syndrome (MS).

METHODSPatients who received elective or emergency cholecystectomies in our center during 23 years were retrospectively evaluated. The data reviewed included demography, clinical presentations, diagnostic methods, surgical procedures, postoperative complications, and follow-up.

RESULTSThere were 27 patients diagnosed with MS among 8697 cholecystectomies performed during that period. The preoperative diagnostic modalities included ultrasonography, computed tomography, magnetic resonance cholangiopancreatography, and endoscopic retrograde cholangiopancreatography. The incidence of MS Type I (12/27, 44.4%) had the dominance in the four types, the incidence of MS Type II and III were 33.3% (9/27) and 22.2% (6/27), and there were no MS Type IV patients. Laparoscopic cholecystectomy was performed in 15 (55.6%) patients, but only 3 (11.1%) patients with MS Type I had a successful surgery, and the other 12 were converted to open cholecystectomy. The remaining 12 patients directly underwent open cholecystectomy. The surgical procedures except laparoscopic cholecystectomy included simply open cholecystectomy (including laparoscopic cholecystectomy converted to open cholecystectomy) (6/27, 22.2%), open cholecystectomy, T-tube placement with choledochotomy (9/27, 33.3%), open cholecystectomy, closure of the fistula with gallbladder cuff, T-tube placement (3/27, 11.1%), and open cholecystectomy with excision of the external bile ducts, and Roux-en-Y hepatico-jejunostomy (6/27, 22.2%). Of them, 88.9% (24/27) patients recovered uneventfully and were discharged in good condition without any operation related mortality.

CONCLUSIONSEndoscopic retrograde cholangiopancreatography is a good method with diagnostic and therapeutic purposes. Total or partial cholecystectomy is generally adequate for MS Type I. For MS Type II-IV, paritial cholecystectomy, choledochoplasty, or if impossible, Roux-en-Y hepatico-jejunostomy may be performed. Laparoscopic cholecystectomy may be successful in selected preoperatively diagnosed MS Type I patients, and open cholecystectomy is the standard therapeutic method.

Adult ; Aged ; Cholecystectomy, Laparoscopic ; Female ; Humans ; Male ; Middle Aged ; Mirizzi Syndrome ; diagnosis ; pathology ; physiopathology ; surgery ; Retrospective Studies

PURPOSE: Xanthogranulomatous cholecystitis_(XGC) is an unusual and destructive inflammatory process of the gallbladder and it's characterized by severe proliferative fibrosis. XGC usually presents with features of chronic cholecystitis or acute cholecystitis, yet clinically, radiologically and macroscopically, XGC may be difficult to differentiate from gallbladder cancer. The purpose of our study was to evaluate the radiologic features of XGC and their correlation with the clinical, pathologic and surgical findings. METHODS: We performed retrospective analysis on 14 cases of XGCs that were operated on between March 1999 and December 2005. The clinical features, preoperative radiologic findings, operative findings and postoperative courses were reviewed. RESULTS: Fourteen cases of XGC were found among 1451 cases of cholecystectomy (0.96%). Mirizzi's syndrome was observed in 35.7% of the patients. Cholelithiasis and a thickened gallbladder wall were frequent findings. The most characteristic CT finding was hypodense intramural nodule like microabscess, and this was seen in 42.8% of the patients. The most characteristic sonographic finding was the presence of hypoechoic nodule in the gallbladder wall, and this was seen in 55.5% of the patients. 9 patients underwent open cholecystectomy including one case of T-tube choledocholithotomy. Four of five patients who underwent laparoscopic cholecystectomy required conversion to open surgery. A malignant lesion was suspected preoperatively in two cases, and both underwent frozen biopsy during surgery. CONCLUSIONS: Although the preoperative diagnosis of XGC is difficult, the presence of hypodense intramural nodule on CT or hypoechoic nodule in the gallbladder wall on sonography is highly suggestive of XGC. As XGC may resemble malignancy, differentiation is essential, via intraoperative frozen biopsy to deliver the optimal surgical treatment.
Biopsy ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis* ; Cholecystitis, Acute ; Cholelithiasis ; Conversion to Open Surgery ; Diagnosis ; Fibrosis ; Gallbladder ; Gallbladder Neoplasms ; Humans ; Mirizzi Syndrome ; Retrospective Studies ; Ultrasonography

BACKGROUNDMirizzi syndrome is often difficult to diagnose before surgery, and is often accompanied by extensive adhesions in the cystohepatic (Calot's) triangle and the difficulty of separating tissue can lead to bile duct injury and other intraoperative and postoperative complications. The aim of this study is to investigate minimally invasive means of treating different types of Mirizzi syndrome.

METHODSFifty-four patients diagnosed with Mirizzi syndrome were enrolled between July 2004 and May 2012. The diagnosis was further refined according to the Csendes classification. Twenty-seven patients were treated with a combination of endoscopic retrograde cholangiopancreatography (ERCP), laparoscopy, and choledochoscopy (tripartite approach group); type I in 16 cases, type II five cases, and type III in six cases. Twenty-seven patients were treated with laparotomy (routine approach group); type I in 19 cases, type II in six cases, and type III in two cases. The operation time, blood loss during operation, initiation of intake time of food, postoperative complications, and hospital stays were compared between two groups.

RESULTSAll patients were successfully cured in surgical operation. The operation time was (49.7 ± 27.5) minutes, blood loss during operation was (21.1 ± 15.9) ml, initiation of intake time of food was (6.3 ± 2.7) hours, postoperative complications were with two cases (7%, 2/27), and hospital stay was (6.7 ± 1.8) days in the tripartite approach group. In the routine approach group, the operation time was (85.1 ± 20.3) minutes, blood loss during operation was (150.3 ± 20.5) ml, initiation of intake time of food was (36.6 ± 10.3) hours, postoperative complications were with three cases (11%, 3/27), and hospital stay was (10.9 ± 3.4) days. Except for postoperative complications, there were significant differences in the operation time, blood loss during operation, initiation of intake time of food, and hospital stays between two groups (P < 0.05).

CONCLUSIONSERCP combined with laparoscopy and choledochoscopy is a safe and effective means of treating Mirizzi syndrome. The approach is minimally invasive and patients recover quickly requiring only brief hospitalization.

Adult ; Aged ; Aged, 80 and over ; Cholangiopancreatography, Endoscopic Retrograde ; methods ; Female ; Humans ; Laparoscopy ; methods ; Male ; Middle Aged ; Mirizzi Syndrome ; diagnostic imaging ; surgery