[Mirizzi syndrome--a contraindication for laparoscopic surgery].
The Mirizzi syndrome refers to a benign obstruction of the common hepatic duct by a stone impacted within the cystic duct or the neck of the gallbladder causing an obstructive jaundice. According to McSherry's subclassification based on endoscopic retrograde cholangio-pancreatography we distinguish a type I, involving an external compression of the common hepatic duct by a large stone impacted in the cystic duct or Hartmann's pouch without lesion of the gallbladder or the common hepatic duct wall. In type II a cholecysto-choledochal fistula is present, caused by a calculous which has already eroded partly or completely into the common bile duct. The type I is better treated with a partial cholecystectomy, the type II with a partial cholecystectomy and a bilio-digestive anastomosis. Due to a severe inflammatory process with dense adhesions and odematous changes of the hepato-duodenal ligament, it is dangerous to prepare the Calot's triangle, in case of conventional cholecystectomy and/or in case of laparoscopic cholecystectomy. From 1986-1991 we have successfully treated 10 patients according to this concept (7 patients with type II, 3 patients with type I). We have no mortality and no lesion of the biliary system. One patient has been reoperated because of a postoperative hemorrhage and biliary fistula. One patient developed a benign stricture which could be dilated two months after the procedure. Two patients were found with an incidental carcinoma of the gallbladder.
Moser
J J
JJ
Klinik für Viszerale und Transplantationschirurgie, Inselspital Bern.
Baer
H U
HU
Glättli
A
A
Schweizer
W
W
Blumgart
L H
LH
Czerniak
A
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic; D002769:Cholelithiasis / Q000601:surgery*; D001651:Cholestasis, Extrahepatic / Q000601:surgery*; D000075202:Contraindications; D003549:Cystic Duct / Q000601:surgery*; D005260:Female; D006500:Hepatic Duct, Common / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013577:Syndrome
Le syndrome de Mirizzi--une contre-indication à la chirurgie laparoscopique.