Management of Mirizzi Syndrome in Emergency.
BACKGROUND
Mirizzi syndrome (MS) is a rare complication of cholelithiasis. Despite the success of laparoscopic cholecystectomy as a minimally invasive approach to gallstone disease, MS remains a challenge, also for open and robotic approaches, due to the subverted anatomy of the hepatocystic triangle. Moreover, when emergency surgery is needed, the optimal preoperative diagnostic assessment could not be always achievable. We aim to analyze our experience of MS treated in emergency and to assess the feasibility of a diagnostic and therapeutic decisional algorithm.


METHODS
From March 2006 to February 2016, all patients with a preoperative diagnosis, or an intraoperative evidence of MS, were retrospectively analyzed at our Academic Hospital, including patients operated on in emergency or in deferred urgency. Eighteen patients were included in the study using exclusion criteria and were treated in elective surgery.


RESULTS
The patients were distributed according to modified Csendes' classification: type I in 15 cases, type II in 2, type III in 0, type IV in 1, and type V in 0. In the type I group, diagnosis was intraoperatively performed. Laparoscopic approach was performed with cholecystectomy or subtotal cholecystectomy, when the hepatocystic triangle dissection was hazardous. Patients with preoperative diagnosis of acute abdomen and MS type IV were directly managed by open approach.


CONCLUSIONS
Diagnosis of MS and the therapeutic management of MS are still a challenge, mostly in an emergency setting. Waiting for standardized guidelines, we propose a decisional algorithm in emergency, especially in nonspecialized centeres of hepatobiliary surgery.
1 Unit of Endocrine, Digestive and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University Medical School "A. Moro" of Bari , Bari, Italy .
Mario
M
Testini
1 Unit of Endocrine, Digestive and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University Medical School "A. Moro" of Bari , Bari, Italy .
Lucia Ilaria
LI
Sgaramella
1 Unit of Endocrine, Digestive and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University Medical School "A. Moro" of Bari , Bari, Italy .
Giuseppe Massimiliano
GM
De Luca
1 Unit of Endocrine, Digestive and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University Medical School "A. Moro" of Bari , Bari, Italy .
Alessandro
A
Pasculli
1 Unit of Endocrine, Digestive and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University Medical School "A. Moro" of Bari , Bari, Italy .
Angela
A
Gurrado
2 Department of General Surgery, University Medical School of Catania , Catania, Italy .
Antonio
A
Biondi
1 Unit of Endocrine, Digestive and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University Medical School "A. Moro" of Bari , Bari, Italy .
Giuseppe
G
Piccinni
D000006:Abdomen, Acute / Q000209:etiology; D000368:Aged; D000465:Algorithms; D017081:Cholecystectomy, Laparoscopic; D002769:Cholelithiasis / Q000150:complications; D000066491:Clinical Decision-Making; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057792:Mirizzi Syndrome / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies
Mirizzi syndrome; cholecystitis; cholelithiasis; gallstone disease