Mirizzi's syndrome. Diagnostic and therapeutic controversies in the laparoscopic era.
BACKGROUND
Mirizzi's syndrome (MS) is an unusual cause of obstructive jaundice. It can mimic bile duct cancer, and the role of laparoscopic surgery is not well defined. The aim of this paper is to report five cases and describe the pitfalls encountered in its diagnosis and treatment with a laparoscopic approach.


METHODS
From January 1992 to January 1996, five cases of MS out of 560 patients with gallstones prospectively treated and recorded were found (0.9%).


RESULTS
There were two men and three women, (mean age: 54 years [30-93]). In one case diagnosis of bile duct carcinoma was established but surgery revealed MS. Four cases were approached by laparoscopy, but all of them were converted: in two, due to a distorted anatomy, in a third due in the difficulty of visualizing the distal end of the bile duct, and in the last case due to the impossibility of retrieving the stones. All were treated with a cholecochorrhaphy over a T tube, except one, in which a hepaticojejunostomy was performed. Morbidity and mortality were nil, and they remain asymptomatic after a mean follow-up of 19 months (3-36).


CONCLUSIONS
MS constitutes an important laparoscopic challenge, both to clearance of duct stones and to the proper reconstruction of the biliary duct. A prudent policy is to perform a dissection trial and convert if local conditions are not clear for an experienced laparoscopic surgeon.
Targarona
E M
EM
Service of General and Digestive Surgery, University of Barcelona, Spain.
Andrade
E
E
Balagué
C
C
Ardid
J
J
Trías
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000175:diagnosis / Q000601:surgery; D001650:Bile Duct Neoplasms / Q000175:diagnosis; D002769:Cholelithiasis / Q000175:diagnosis* / Q000601:surgery*; D002779:Cholestasis / Q000175:diagnosis* / Q000601:surgery*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged