MIRIZZI-SYNDROME - CHOICE OF SURGICAL-PROCEDURE IN THE LAPAROSCOPIC ERA

Impaction of a calculus in gallbladder neck or cystic duct or even in its remnant may produce common hepatic duct stricture by direct mechan ical impression or associated inflammation. This clinical entity is re ferred to as Mirizzi syndrome. Four patients were operated on for Miri zzi syndrome. This represents 0.9% of the 444 patients who underwent l aparoscopic cholecystectomy in our clinic. Two cases with Mirizzi synd rome type I, one of which had a stone in a gallbladder remnant, were s uccessfully treated by laparoscopic cholecystectomy without any compli cations, One patient developed a bile leakage; fistulography via a sum p drain revealed bile leakage from the laceration site of the stone, a nd: the patient was reoperated on to perform a Roux-en-Y hepaticojejun ostomy. The patient was lost due to cardiopulmonary arrest originating from septic shock. In another case diagnosed as Mirizzi type Il, the operation was converted to an open procedure due to intense inflammati on and fibrosis around the area of the Calot's triangle. Subtotal chol ecystectomy was done and the defect on the common hepatic duct repaire d by means of a gallbladder flap over the T tube.