A-Hon Kwon1, Hiroaki Inui. 1. Department of Surgery, Kansai Medical University, Osaka, Japan. kon@takii.kmu.ac.jp <kon@takii.kmu.ac.jp>
Abstract
BACKGROUND: The role of laparoscopic procedures in the treatment of Mirizzi syndrome (MS) is not well-defined and remains controversial. We evaluated the preoperative diagnosis and efficacy of laparoscopic procedures in treatment of MS. STUDY DESIGN: Preoperative diagnosis and cholecystectomy were attempted on 2,012 consecutive patients at a single center and 24 (1.2%) were finally diagnosed with MS. Patients without preoperative endoscopic retrograde cholangiography underwent preoperative spiral CT after IV infusion cholangiography (IVC-SCT). RESULTS: Fourteen patients had McSherry type I MS (MS I) and 10 had type II MS (MS II). Open operation was performed on patients with MS II or a preoperative suspicion of gallbladder cancer. Laparoscopic cholecystectomy (LC) was performed successfully on 10 of 14 patients with MS I and the remaining 4 patients with MS I were converted to open procedure. At preoperative endoscopic retrograde cholangiography (n = 3) or IVC-SCT (n = 11) on patients with MS I, 3 of 4 (75%) patients who were converted to open operation had a nonvisualized cystic duct, and 9 of 10 (90%) patients with LC had a visualized cystic duct. CONCLUSIONS: MS I with a visualized cystic duct can be considered to be an indication for laparoscopic operation. IVC-SCT can be a useful tool for correct preoperative diagnosis and assessment of the feasibility of LC in patients with MS I.
BACKGROUND: The role of laparoscopic procedures in the treatment of Mirizzi syndrome (MS) is not well-defined and remains controversial. We evaluated the preoperative diagnosis and efficacy of laparoscopic procedures in treatment of MS. STUDY DESIGN: Preoperative diagnosis and cholecystectomy were attempted on 2,012 consecutive patients at a single center and 24 (1.2%) were finally diagnosed with MS. Patients without preoperative endoscopic retrograde cholangiography underwent preoperative spiral CT after IV infusion cholangiography (IVC-SCT). RESULTS: Fourteen patients had McSherry type I MS (MS I) and 10 had type II MS (MS II). Open operation was performed on patients with MS II or a preoperative suspicion of gallbladder cancer. Laparoscopic cholecystectomy (LC) was performed successfully on 10 of 14 patients with MS I and the remaining 4 patients with MS I were converted to open procedure. At preoperative endoscopic retrograde cholangiography (n = 3) or IVC-SCT (n = 11) on patients with MS I, 3 of 4 (75%) patients who were converted to open operation had a nonvisualized cystic duct, and 9 of 10 (90%) patients with LC had a visualized cystic duct. CONCLUSIONS:MS I with a visualized cystic duct can be considered to be an indication for laparoscopic operation. IVC-SCT can be a useful tool for correct preoperative diagnosis and assessment of the feasibility of LC in patients with MS I.
Authors: Sujit S Kulkarni; Mayo Hotta; Linda Sher; Robert R Selby; Dilipkumar Parekh; James Buxbaum; Maria Stapfer Journal: Surg Endosc Date: 2016-09-01 Impact factor: 4.584
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