title: A Minimally Invasive Strategy for Mirizzi Syndrome Type II: Combined Endoscopic With Laparoscopic Approach.
abstract: BACKGROUND
  Mirizzi syndrome (MS) is a rare complication of the gallstone disease. Despite the fact that successful laparoscopic treatments have been reported for MS type I, open surgery remains the gold standard approach for MS type II because of the technical difficulties involved.
  
  
  OBJECTIVE
  The aim of this study is to determine the best technique for patients with MS type II by comparing the duration of surgery, loss of blood, rates of complication, duration of hospitalization, and outcomes of long-term follow-up.
  
  
  METHODS
  From January 2009 to September 2014, combined endoscopic retrograde cholangiopancreatography with laparoscopic surgery for MS type II was implemented. Patients' demographics and treatment outcomes were collected prospectively and during the follow-up.
  
  
  RESULTS
  Forty-nine patients with MS type II were managed with this strategy. Laparoscopic subtotal cholecystectomy was successfully performed in all the patients without conversion or morbidity. When compared with a historical cohort of 57 patients who underwent a surgery for MS, this group of patients had significantly shorter duration of hospitalization (7.21±1.61 vs. 15.31±3.82 d, P<0.01). It also showed less blood loss (162.81±40.83 vs. 207.55±37.01 mL, P=0.425) and less postoperative complications (10.20% vs. 14.04%, P=0.594), although the duration of surgery (165.73±54.33 vs. 156.04±48.61 min, P=0.334) was longer, but these were not statistically significant. However, no significant difference in the rate of recurrence (4.55% vs. 9.52%, P=0.522) of choledocholithiasis was found.
  
  
  CONCLUSIONS
  The MS type II can be effectively managed with a laparoscopic surgery combined with preoperative endoscopic retrograde cholangiopancreatography, which is feasible and minimally invasive.
authors.affiliation: *Department of Minimally Invasive Surgery, Tianjin Nankai Hospital, Tianjin †Department of Ultrasonography, Dalian Traditional Chinese Medical Hospital, Liaoning Province, China.
authors.forename: Haicheng
authors.initials: H
authors.lastname: Yuan
authors.forename: Tian
authors.initials: T
authors.lastname: Yuan
authors.forename: Xiangyu
authors.initials: X
authors.lastname: Sun
authors.forename: Mingwei
authors.initials: M
authors.lastname: Zheng
mesh_terms: D016063:Blood Loss, Surgical; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057792:Mirizzi Syndrome / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome