title: Surgical management of Mirizzi syndrome.
abstract: OBJECTIVE
  Mirizzi syndrome is an unusual presentation of prolonged cholelithiasis. This study aimed to analyze the diagnostic methods, operative strategies, and outcome of the surgical treatment of patients with Mirizzi syndrome.
  
  
  METHODS
  We retrospectively evaluated the patients with Mirizzi syndrome treated in our General Surgery Clinic. The data collected included demographic variables, clinical presentation, diagnostic methods, surgical procedures, and postoperative complications.
  
  
  RESULTS
  The study included 13 male and 21 female patients, with a mean age of 67.2 years. The incidence of Mirizzi syndrome was determined as 0.6% (34/5632), and type II was more frequently observed (52.9%); no patient was determined as type IV. The incidences of types I and III were 35.2% and 11.7%, respectively. Among the preoperative diagnostic evaluations, ultrasonography was the initial imaging study that was performed in all patients. Computerized tomography, magnetic resonance cholangiopancreatography, and endoscopic retrograde cholangiopancreatography were the other radiological studies. Surgical procedures included cholecystectomy for 83% of the patients with type I. The remaining cases and 14 of the type II patients (77.7%) underwent choledochotomy and T-tube insertion following cholecystectomy. Four of the patients with type II variety and all of the type III patients underwent cholecystectomy and roux-en-Y hepaticojejunostomy. All of the patients had complete recovery, with a morbidity rate of 5.8%, and there was no hospital mortality.
  
  
  CONCLUSIONS
  The essential part of the management of patients with Mirizzi syndrome is to determine the best surgical procedure in the preoperative period. In type I patients, simple cholecystectomy is generally enough, but sometimes T-tube insertion may be required, while the cases with types II-IV require more complex surgical approach, such as cholecystectomy and bilioenteric anastomosis. Roux-en-Y hepaticojejunostomy is an appropriate procedure with good outcome.
authors.affiliation: Departments of General Surgery and Gastroenterology, Ege University, School of Medicine, Izmir.
authors.forename: Unal
authors.initials: U
authors.lastname: Aydin
authors.forename: Pinar
authors.initials: P
authors.lastname: Yazici
authors.forename: Ismail
authors.initials: I
authors.lastname: Ozsan
authors.forename: Galip
authors.initials: G
authors.lastname: Ersõz
authors.forename: Omer
authors.initials: O
authors.lastname: Ozütemiz
authors.forename: Murat
authors.initials: M
authors.lastname: Zeytunlu
authors.forename: Ahmet
authors.initials: A
authors.lastname: Coker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002769:Cholelithiasis / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D015994:Incidence; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013577:Syndrome; D016896:Treatment Outcome