Critical Appraisal of the Impact of the Systematic Adoption of Advanced Minimally Invasive Hepatobiliary and Pancreatic Surgery on the Surgical Management of Mirizzi Syndrome

A Novel Surgical Approach for Type 2 Mirizzi Syndrome: Based on a Decade of Clinical Experience at a Teaching Hospital

Background. The Mirizzi syndrome (MS) is a rare complication of cholecystolithiasis that is often accompanied by severe inflammation and fibrosis around Calot's triangle. It is difficult to treat Type 2 MS surgically, and the treatment for this condition has not yet been standardized. The data on operative management are limited. The study aimed to review our institutional clinical experience regarding surgery and provide recommendations for treating Type 2 MS. Methods: We conducted a retrospective study on 6 patients with MS who were surgically treated at our institution between January 2010 and December 2019. The classification of MS by McSherry CK, Ferstenberg H, Virshup M. The Mirizzi syndrome: Suggested classification and surgical therapy. Surg Gastroenterol. 1982;1:219-225 was used. Mucosal approach was used to treat Type 2 MS. The parameters for comparison included patient demographics, operative procedures, operation time, blood loss, length of hospital stay, complications, and follow-up. Results: There were 23 patients with MS among 10 386 cholecystectomies in our area. Six patients with Type 2 MS had successful surgery, and the mucosal approach was used. The average operative time was 253.3 ± 32.5 minutes. The average blood loss was 70.0 ± 14.1 mL. The mean postoperative hospital stay was 9.5 ± 3.9 days. There was no postoperative mortality. The most frequent postoperative complications were bile leakage (16.7%), and postoperative intra-abdominal collection (16.7%). The mean postoperative follow-up was 10 months, and all patients are asymptomatic. The mucosal approach may decrease the risk of bile duct injury, biliary tract infection, and blood loss more than other surgical approaches. Conclusion: This study demonstrates that the mucosal approach is an effective surgical procedure for Type 2 MS.