title: Update on the diagnosis and treatment of mirizzi syndrome in laparoscopic era: our experience in 7 years.
abstract: BACKGROUND
  Mirizzi syndrome (MS) is a rare complication of cholelithiasis. The objective of this study was to assess the current incidence of MS in our area and present our experience in the clinical, diagnostic, and therapeutic management, focussing in laparoscopic approach.
  
  
  METHODS
  We prospectively analyzed 35 cases of MS between January 2006 and November 2012, collecting information regarding demographics, clinical management, diagnostic methods, surgical procedure, postoperative morbidity, and follow-up. All patients underwent abdominal ultrasonography. In patients with suspected obstructive jaundice, magnetic cholangiography resonance and endoscopic retrograde cholangiopancreatogram were performed preoperatively, detecting MS in 68.5% of patients.
  
  
  RESULTS
  The incidence of MS was 2.8% in 1168 cholecystectomies for cholelithiasis. There were 13 men and 22 women, with a mean age of 70.1 years. Nineteen patients had MS type I (54.2%). Fourteen were treated with laparoscopic cholecystectomy (LC) successfully, whereas 3 conversions were performed because of difficult surgical dissection. In the remaining 2, subtotal cholecystectomy was performed. Seven patients had type II MS (20%). In 5 cases cholecystectomy and bile duct repair were performed with T-tube placement (in 4 by laparoscopic approach), in another one subtotal cholecystectomy with primary biliary choledochorrhaphy was performed, because of dilated bile duct. Finally, the remaining patients with type III and IV SM (14.2% and 11.4%, respectively) were treated with Roux-en-Y hepaticojejunostomy.We observed 14.5% morbidity, highlighting 2 cases of postoperative collection and 1 case of biliary fistula. There was no postoperative mortality. The mean follow-up of patients was 13.4±4 months.
  
  
  CONCLUSIONS
  Preoperative diagnosis of MS is difficult, but it is essential in the proper management of the disease. Investigations as magnetic cholangiography resonance and endoscopic retrograde cholangiopancreatogram contribute to the success of preoperative identification. LC should be reserved to MS type I and type II highly selected cases. This pathology should be treated by experienced surgeons to decrease the risk of iatrogenia.
authors.affiliation: Hepatobiliary Unit, Department of General Surgery, Hospital Universitari y Politecnic "La Fe," Valencia, Spain.
authors.forename: Jose B
authors.initials: JB
authors.lastname: Lledó
authors.forename: Sebastian M
authors.initials: SM
authors.lastname: Barber
authors.forename: Jose C
authors.initials: JC
authors.lastname: Ibañez
authors.forename: Antonio G
authors.initials: AG
authors.lastname: Torregrosa
authors.forename: R
authors.initials: R
authors.lastname: Lopez-Andujar
mesh_terms: D000368:Aged; D017081:Cholecystectomy, Laparoscopic; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D057792:Mirizzi Syndrome / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care; D011446:Prospective Studies; D012189:Retrospective Studies