Mirizzi syndrome: An extra hazard for laparoscopic surgery

Background: Mirizzi Syndrome (MS) is an important but uncommon complication of gallstones characterized by narrowing of the common hepatic duct (CHD) due to mechanical compression or inflammation. This study aimed to assess t he impact of preoperative and intraoperative diagnosis of MS on the perform ance, safety and efficacy of laparoscopic cholecystectomy. Methods: From a consecutive series of 1281 patients having surgery for gall bladder disease between 1990 and 1998, nine patients with MS were identifi ed from a prospective database and their clinical progress examined. Results: Five out of the nine patients with MS presented with pain (2/5 wer e also jaundiced), and four presented with acute cholecystitis. Liver funct ion tests were abnormal in all patients. Preoperative diagnosis of MS based on ultrasound was made in only two patients, and in a third on findings of a nasobiliary cholangiogram. In six patients, the diagnosis was intraopera tive. In seven patients cholecystectomy was completed by laparoscopy. Two p atients needed conversion to open cholecystectomy. In two patients the comm on bile duct was mistaken for the cystic duct and the error was recognized on relaxation of traction on the gall bladder in one, but in the other a du ct injury occurred that was not recognized until the postoperative period. Conclusions: Preoperative diagnosis of MS is difficult, and a high index of suspicion is necessary to avoid serious complications. Once the diagnosis is known, successful laparoscopic management is possible but care should be taken to avoid duct injury.