title: Laparoscopic transfistulous bile duct exploration for Mirizzi syndrome type II: a simplified standardized technique.
abstract: Laparoscopic treatment is a viable option for Mirizzi syndrome (MS) type I, but it is not recommended for MS type II (McSherry classification). We introduce laparoscopic transfistulous bile duct exploration (LTBDE) as a simplified standardized technique for MS type II.
  
  
  
  Eleven consecutive LTBDEs performed by a surgeon for MS type II were analyzed retrospectively, including three successful single-incision LTBDEs (SILTBDEs). Transfistulous stone removal followed by primary closure of gallbladder remnant and partial cholecystectomy was performed. An additional choledochotomy was required in one patient.
  
  
  
  Preoperative endoscopic retrograde cholangiopancreatography and operative findings confirmed the diagnosis of MS in five and five patients, respectively. Preoperative ultrasound implied the remaining diagnosis. The operative time was 270.5 ± 65.5 min. The stone clearance rate was 100 %. The postoperative length of hospital stay was 5.1 ± 2.2 days. There was no open conversion. Overall complications comprised two postoperative transient hyperamylasemia (18.2 %) and one superficial wound infection (9.1 %). Compared with the other group of 92 patients who underwent laparoscopic bile duct exploration, the MS type II group had a significantly younger age, a higher jaundice rate, a lower single-incision laparoscopic approach rate, a lower choledochotomy rate, longer operative time, a lower postoperative pethidine dose, and a longer total length of hospital stay. The average follow-up period was 12.1 months.
  
  
  
  LTBDE is safe and efficacious for MS type II including Csendes type IV. A high suspicion of MS is critical. SILTBDE is feasible in selected cases. Long-term follow-up is mandatory.
authors.affiliation: Department of Surgery, MacKay Memorial Hospital, Hsin-Chu Branch, No. 690, Sec. 2, Guangfu Road, Hsin-Chu, 30071, Taiwan.|Department of Healthcare Management, Yuanpei University of Medical Technology, Hsin-Chu, Taiwan.
authors.forename: Shu-Hung
authors.initials: SH
authors.lastname: Chuang
authors.affiliation: Department of Surgery, MacKay Memorial Hospital, Hsin-Chu Branch, No. 690, Sec. 2, Guangfu Road, Hsin-Chu, 30071, Taiwan.
authors.forename: Meng-Ching
authors.initials: MC
authors.lastname: Yeh
authors.affiliation: Department of Surgery, MacKay Memorial Hospital, Hsin-Chu Branch, No. 690, Sec. 2, Guangfu Road, Hsin-Chu, 30071, Taiwan. 4882@mmh.org.tw.
authors.forename: Chien-Jen
authors.initials: CJ
authors.lastname: Chang
mesh_terms: D000328:Adult; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic; D042883:Choledocholithiasis / Q000175:diagnosis / Q000601:surgery; D003135:Common Bile Duct / Q000601:surgery; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D057792:Mirizzi Syndrome / Q000175:diagnosis / Q000601:surgery*; D061646:Operative Time; D012189:Retrospective Studies
keywords: Choledochotomy; Cystocholedochal; Infundibulotomy; Laparoscopic bile duct exploration; Mirizzi syndrome; Single-incision laparoscopic surgery; Transfistulous