Purpose: Mirizzi's syndrome in one of the infrequent etiologies of obstructive jaundice owing to the calculus impaction at cystic duct or gallbladder neck, causing compression of bile duct or erosion of cystic duct-bile duct septum. Not
only
the
correct diagnosis of this entity is difficult, but also its management. Laparoscopic approach has been attempted with variable success. The objective was to analize the feasibility of laparoscopic approach in Mirizzi's syndrome.
Method: From January 2000 to March 2001, ten patients with Mirizzi's syndrome were idenified and laparoscopically managed. All patients had cholelithiasiasis with acute inflammation and one of them, also choledocholithiasis. Subtotal
cholecystectomies were performed and cystic duct stumps were closed with laparoscopic suture devices.
Results: There were 8 men and 2 women, and the mean age was 55.7(range, 27-71) years. All patients had mild to moderate degress of jaundice(mean total bilirubin 2.24 ㎎/dl, rang from 1.24-7.84 ㎎/dl). The mean operative time was 143
(range,
70-200) minutes. All patients were successfully treat laparoscopically but one patient showed signs of bile leak which lasted for 72 hr and spontaneously closed. Mean hospital stay was 4.9(range, 3-9) days.
Conclusions: Laparoscpic treatment of Mirizzi's syndrome is feasible and safe if high-skilled laparoscopic surgeon is available who can determine the appropriate moment for conversion to open surgery. Sometimes, preoperatively placed
endoscopic
nasobiliary drainage catheter is helpful in identifying the distorted anatomy.
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