Page 39 - Journal of Laparoscopic Surgery

10.5005/jp-journals-10007-1139
REVIEW ARTICLE
William Wachira Kibe
The Role of Laparoscopy in the Management of

Mirizzi’s Syndrome: A Review of Literature

William Wachira Kibe
Senior Registrar, Department of General Surgery, Outspan Hospital, Nyeri, Kenya

ABSTRACT

Minimal access surgery is increasingly becoming the preferred approach to general surgical treatment. Operative experience in the last
two decades has established its efficacy and indeed safety in many trials at different centers all over the world.
Laparoscopic cholecystectomy (LC) has therefore become the gold standard of care for patients requiring removal of the gallbladder
over this period. In 1992, a National Institute of Health (NIH) consensus development conference concluded that ‘laparoscopic
cholecystectomy provides a safe and effective treatment for most patients with symptomatic gallstones, laparoscopic cholecystectomy
appears to have become the procedure of choice for many of these patients’.
The objective of this study was to review the literature on the use of laparoscopy in the management of Mirizzi’s syndrome so as
determine its role if any in current and future practice.
Keywords: Laparoscopic management of Mirizzi’s syndrome, Cholelithiasis, Choledocholithiasis.

INTRODUCTION or may not be present. Acute presentations of the syndrome

Mirizzi’s syndrome is a rare cause of acquired jaundice. It is may include features of pancreatitis and cholecystitis.
caused by chronic gallbladder inflammation and large biliary Mirizzi’s syndrome is therefore a form of obstructive
stones resulting in compression of the common hepatic duct. jaundice caused by a stone impacted in the gallbladder neck or
It occurs in approximately 0.1% of patients with gallstone the cystic duct that impinges on the common hepatic duct with
disease and 0.7 to 1.4% of patients undergoing cholecystectomy or without a cholecystocholedochal fistula. This syndrome is a
and it affects male and female equally, but tends to affect older rare complication of cholelithiasis that accounts for 0.1% of all
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people more often. There is no evidence of race having any patients with gallstone disease. Preoperative recognition is
bearing on the epidemiology. The pathogenesis of this necessary to prevent injury to the common duct during surgery.
syndrome relates to multiple and large gallstones which can OBJECTIVES
reside chronically in the Hartmann’s pouch of the gallbladder, The objectives of this study were to review the medical literature
causing undue inflammation, necrosis, scarring and ultimately
fistulation into the adjacent common hepatic duct (CHD). As a available on the efficacy and safety of laparoscopic surgery in
the management of Mirizzi’s syndrome.
result, the CHD becomes obstructed by either scar or stone,
resulting in obstructive jaundice. MS is therefore attributed to
extrinsic compression of the common hepatic duct by gallstones
impacted in the cystic duct or the gallbladder neck. Bile duct
wall necrosis and subsequent cholecystobiliary fistula caused
by chronic inflammation is a rare sequence of the disease. 8
It can be divided into four types (Fig. 1). There are as follows:
1. Type I: No fistula present I II
• Type IA—presence of the cystic duct
• Type IB—obliteration of the cystic duct
2. Types II-IV: Fistula present
• Type II—defect smaller than 33% of the CBD diameter
• Type III—defect 33 to 66% of the CBD diameter
• Type IV—defect larger than 66% of the CBD diameter.
Mirizzi’s syndrome has no consistent or unique clinical
features that distinguish it from other more common forms of
obstructive jaundice. Symptoms of recurrent cholangitis, III IV
jaundice, right upper quadrant pain, generalized body itch, Fig. 1: Schematic representation of Csendes classification for
elevated serum bilirubin and serum alkaline phosphatase may Mirizzi’s syndrome 4

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