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Appraisal of diagnosis and surgical approach for M irizzi syndrome
Author(s) -
Cui Yunfeng,
Liu Yong,
Li Zhonglian,
Zhao Erpeng,
Zhang Hongtao,
Cui Naiqiang
Publication year - 2012
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2012.06149.x
Subject(s) - medicine , magnetic resonance cholangiopancreatography , cholecystectomy , endoscopic retrograde cholangiopancreatography , surgery , gallbladder , incidence (geometry) , complication , fistula , general surgery , pancreatitis , physics , optics
Background M irizzi syndrome is an important and rare complication of gallstone disease. This study aims to evaluate the treatment approach by analysing the diagnostic method and the outcome of surgical treatment in our hospital. Methods We retrospectively analysed the data of 198 patients with M irizzi syndrome between J anuary 2004 and J anuary 2010. The records were reviewed for demography, clinical presentation, diagnostic method, operative procedure, postoperative complication and follow‐up. Results The incidence of M irizzi syndrome was 0.66% of 29 875 patients who underwent cholecystectomy for cholelithiasis. The incidence of types I , II , III and IV was 59.1%, 24.7%, 13.1% and 3.1%, respectively. In this study, ultrasonography and magnetic resonance cholangiopancreatography (MRCP) could have the suspicion of M irizzi syndrome in 77.8% and 82.3% of cases. Cholecystectomy also has been shown to be effective for type I M irizzi syndrome. Our common surgical approach in M irizzi syndrome types II and III was partial cholecystectomy without removal of the portion of gallbladder around the fistula margin. For some cases, choledochoplasty was needed. For M irizzi syndrome type IV , we performed hepaticojejunostomy for all patients. Conclusion Ultrasound, MRCP and endoscopic retrograde cholangiopancreatography in combination with choledochoscope procedure in operation could improve the diagnostic sensitivity of M irizzi syndrome. Intraoperative choledochoscope is effective to confirm M irizzi syndrome during operation. Open surgery is the current standard for managing patients with M irizzi syndrome. Laparoscopic surgery should be confined to M irizzi syndrome type I and patients should be selected very strictly.