MANAGEMENT OF MIRIZZIS-SYNDROME IN THE LAPAROSCOPIC ERA

Background: Mirizzi's syndrome is an uncommon cause of common hepatic duct obstruction resulting from-gallstone impaction in the cystic duct or gallbladder neck. The role of laparoscopic surgery:in:the treatmen t of this condition is still not well defined. This article reports;si x cases of-Mirizzi's syndrome and comments on the management of this c ondition using the laparoscopic approach. Methods: A review of 878 con secutive cholecystectomies from July 1991 to July 1996 identified six cases of Mirizzi's syndrome (0.7%) that were approached laparosdopical ly. Results: This study involved three men and three women with mean a ge of 64 (range, 57-70) years. All cases were approached by laparoscop y. One case was converted because of unclear anatomy in the Calot's tr iangle due to dense adhesions; open cholecystectomy, exploration of th e common bile duct and T-tube insertion was performed. The other five cases were successfully managed laparoscopically. Subtotal cholecystec tomy was performed in two cases, and in three patients with cholecysto choledochal fistula, the defect was closed over a T tube. There was no postoperative morbidity or mortality. A follow-up period of 8 to 17 ( mean, 12) months revealed no complications. Conclusions: Laparoscopic management of Mirizzi's syndrome is feasible and safe but can be techn ically demanding. A policy of trial dissection by an experienced lapar oscopic surgeon is recommended, and if anatomy remains unclear, it is prudent to convert.