title: Laparoscopic approach is safe and effective in the management of Mirizzi syndrome.
abstract: BACKGROUND
  Mirizzi syndrome (MS), an unusual complication of gallstone disease is due to mechanical obstruction of the common hepatic duct and is associated with clinical presentation of obstructive jaundice. Pre-operative identification of this entity is difficult and surgical management constitutes a formidable challenge to the operating surgeon.
  
  
  OBJECTIVE
  To analyse the clinical presentation, pre-operative diagnostic strategies, operative management and outcome of patients operated for MS in a tertiary care centre.
  
  
  METHODS
  This retrospective study identified patients operated for MS between January 2006 and August 2013 and recorded and analysed their pre-operative demographics, pre-operative diagnostic strategies, operative management, and outcome.
  
  
  RESULTS
  A total of 20 patients was identified out of 1530 cholecystectomies performed during the study period giving an incidence of 1.4%. There were 11 males and 9 females with a mean age of 55.6 years. Abdomen pain and jaundice were predominant symptoms and alteration of liver function test was seen in 14 patients. Endoscopic retrograde cholangiopancreatography (ERCP) the mainstay of diagnosis was diagnostic of MS in 72% of patients, while the rest were identified intra-operatively. The most common type of MS was Type II with an incidence of 40%. Cholecystectomy was completed by laparoscopy in 14 patients with a conversion rate of 30%. A choledochoplasty was sufficed in most of the patients and none required a hepaticojejunostomy. The laparoscopic cohort had a shorter length of hospital stay when compared to the entire group.
  
  
  CONCLUSIONS
  MS, a rare complication of cholelithiasis is a formidable diagnostic and therapeutic challenge and pre-operative ERCP as a main diagnostic strategy enables the surgeon to identify and minimize bile duct injury. A choledochoplasty might be sufficient in the majority of the types of MS, while a laparoscopic approach is feasible and safe in most cases as well.
authors.affiliation: Department of Gastrointestinal Surgery, PVS Memorial Hospital, Cochin, Kerala, India.
authors.forename: Naduthottam Palaniswami
authors.initials: NP
authors.lastname: Kamalesh
authors.affiliation: Department of Gastrointestinal Surgery, PVS Memorial Hospital, Cochin, Kerala, India.
authors.forename: Kurumboor
authors.initials: K
authors.lastname: Prakash
authors.affiliation: Department of Gastrointestinal Surgery, PVS Memorial Hospital, Cochin, Kerala, India.
authors.forename: Kaniyarakal
authors.initials: K
authors.lastname: Pramil
authors.affiliation: Department of Gastrointestinal Surgery, PVS Memorial Hospital, Cochin, Kerala, India.
authors.forename: Thaliyachira Deepak
authors.initials: TD
authors.lastname: George
authors.affiliation: Department of Gastrointestinal Surgery, PVS Memorial Hospital, Cochin, Kerala, India.
authors.forename: Aikot
authors.initials: A
authors.lastname: Sylesh
authors.affiliation: Department of Gastrointestinal Surgery, PVS Memorial Hospital, Cochin, Kerala, India.
authors.forename: Ponnambathayil
authors.initials: P
authors.lastname: Shaji
keywords: Endoscopic retrograde cholangiopancreatography; Mirizzi syndrome; laparoscopy