Management of Mirizzi syndrome: A new surgical approach

Background: In a prospective study of a patient population of 1340 with bil iary calculus disease, that ran from January 1993 to December 1997, 34 pati ents (2.53%) were identified as having Mirizzi syndrome. Eight patients wer e found to have type I (A and B) and 26 patients were found to have type II Mirizzi syndrome. A history of recurrent biliary colic and jaundice was pr esent in the majority of patients. Methods: Ultrasonography was helpful in five patients and endoscopic retrog rade cholangiopancreatography was helpful in 17 patients in the diagnosis o f this condition. Because the amount of gall bladder tissue used in choledo choplasty is not yet standardized, a new policy regarding choledochoplasty was adopted. In type IA, retrograde cholecystectomy with simple closure of cystic duct was carried out. In type IB, retrograde cholecystectomy and cho ledochoplasty with 5 mm cuff of the gall bladder was carried out. In type I I lesions the procedure depended on the size of fistula. Patients with fist ula sizes of less than one-third of the common bile duct diameter underwent choledochoplasty with 5 mm cuff of the gall bladder, and patients with fis tula sizes between one-third and two-thirds of the diameter of the common b ile duct underwent choledochoplasty with 10 mm cuff of the gall bladder. Pa tients with fistula sizes of more than two-thirds of the common bile duct d iameter underwent Roux-en-Y hepaticojejunostomy. Results: There was no operative mortality and the complication rate was 17. 64%. Conclusion: Although, out of 26 choledochoplasties, we encountered only one (3.84%) stump stone in a maximum follow-up period of 59 months, further lo ng-term follow-up studies are required to prove the efficacy of the procedu re.