Mirizzi syndrome: ten years experience from a teaching hospital in Riyadh.
OBJECTIVE
Mirizzi syndrome (MS) is an uncommon presentation of cholelithiasis. This study aims to find the incidence and analyze the outcome of management of this condition at Riyadh Medical Complex (RMC) with particular reference to diagnostic methods and outcome of surgical treatment.


METHODS
Retrospective study on 17 consecutive patients of MS diagnosed and managed at RMC over ten year period. The records were reviewed for demography, clinical presentation, diagnostic methods, operative procedures, postoperative complication and follow up.


RESULTS
The incidence of MS syndrome was 0.7% of 2415 cholecystectomies. There was preponderance of Type I variety (58.8%). Ultrasonography was able to diagnose 82% cases. ERCP suggested the diagnosis in all cases and helped further in classifying and management of these patients. All Type I cases were managed with partial cholecystectomy, two underwent laparoscopic surgery. Three Type II patients were managed by partial cholecystectomy alone. Three patients with Type III variety had choledochoplasty whereas one remaining patient with Type IV variety underwent hepatico-jejunostomy. All patients had complete recovery with 17.6% procedure-related morbidity and no hospital mortality. All patients are doing well over a mean follow up 6.5 years.


CONCLUSIONS
Preoperative diagnosis of Mirizzi syndrome by ultrasound and ERCP is essential to prevent serious complications during surgery. Partial cholecystectomy is an adequate procedure for Types I & II MS. Choledochoplasty provides an effective surgical repair in Type III cases. Although laparoscopic cholecystectomy in MS may be hazardous, it may still be tried in preoperatively diagnosed type I cases, provided the surgeon is experienced and keeps a low threshold for conversion open surgery.
Al-Akeely
Mohammed H A
MH
Department of General Surgery, College of Medicine, King Saud University, P.O. Box 2925, Riyadh, 11461, Kingdom of Saudi Arabia.
Alam
Mohammed K
MK
Bismar
Hayan Abdulrahman
HA
Khalid
Kamran
K
Al-Teimi
Ibrahim
I
Al-Dossary
Nasser Faleh
NF
D000328:Adult; D000368:Aged; D001662:Biliary Tract Surgical Procedures; D002769:Cholelithiasis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D001651:Cholestasis, Extrahepatic / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D003549:Cystic Duct; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012529:Saudi Arabia; D013577:Syndrome; D016896:Treatment Outcome