title: Mirizzi's syndrome--results from a large western experience.
abstract: BACKGROUND
  This paper reports a series of patients with Mirizzi's syndrome (MS) who were managed at our institution over an 11-year (1994-2005) period.
  
  
  METHODS
  Retrospective case note study of patients with a definitive or possible diagnosis of MS stated in radiology reports were identified using the hospital's radiology computer coding system.
  
  
  RESULTS
  33 patients were identified with a median age of diagnosis of 70 (35-90) years and male to female ratio of 15:18. Liver function tests were deranged in all patients. Pre-operative radiological diagnosis was achieved in 28 patients: ultrasound scan (n = 4), computer tomography (n = 3), magnetic resonance cholangiopancreatography (n = 10) and endoscopic retrograde cholangiopancreatography (n = 11). Five patients were diagnosed intra-operatively. Type I MS was reported in 27 patients. Laparoscopic cholecystectomy was attempted in 18 patients with 6 being converted to open cholecystectomy. Six patients had biliary stent insertion only and 3 were conservatively managed. Six patients had type II MS, 4 were treated with open cholecystectomy and Roux-en-Y hepaticojejunostomy, 1 underwent an open subtotal cholecystectomy with fistula closure and 1 had percutaneous biliary stent insertion only. The median follow-up period was 2 (1-7) months (n = 18). 10 patients are currently under follow-up. Overall morbidity was 27% (n = 8) and mortality was 7% (n = 2).
  
  
  CONCLUSIONS
  Pre-operative diagnosis of MS can be achieved using MRCP. Laparoscopic cholecystectomy for type I MS is a safe option and type II MS can be treated with Roux-en-Y hepaticojejunostomy or subtotal cholecystectomy with fistula closure.
authors.affiliation: The Hepatopancreatobiliary Unit, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF United Kingdom.
authors.forename: D
authors.initials: D
authors.lastname: Gomez
authors.forename: S H
authors.initials: SH
authors.lastname: Rahman
authors.forename: G J
authors.initials: GJ
authors.lastname: Toogood
authors.forename: K R
authors.initials: KR
authors.lastname: Prasad
authors.forename: J P A
authors.initials: JP
authors.lastname: Lodge
authors.forename: P J
authors.initials: PJ
authors.lastname: Guillou
authors.forename: K V
authors.initials: KV
authors.lastname: Menon