|
|
Multidisciplinary management of Mirizzi syndrome with cholecystobiliary fistula: the value of minimally invasive endoscopic surgery |
Fabien Le Roux, Charles Sabbagh, Brice Robert, Thierry Yzet, Laurent Dugue, Jean-Paul Joly and Jean-Marc Regimbeau |
Amiens, France
Author Affiliations: Department of Digestive and Oncological Surgery (Le Roux F, Sabbagh C and Regimbeau JM); Department of Interventional and Diagnostic Imaging (Robert B and Yzet T); and Department of Hepatogastroenterology (Joly JP), Amiens University Hospital, Jules Verne University of Picardie, Amiens, France; Department of Digestive Surgery, Saint-Camille Hospital, Bry-sur-Marne, France (Dugue L)
Corresponding Author: Professor Jean-Marc Regimbeau, Department of Digestive and Oncological Surgery, Amiens University Hospital, Place Victor Pauchet, F-80054 Amiens cedex 1, France (Email: regimbeau.jean-marc@chu-amiens.fr) |
|
|
Abstract Mirizzi syndrome, a rare complication of gallstones, is defined by obstruction of the main bile duct. This obstruction may worsen and thus result in cholecystobiliary fistula. Surgical management of Mirizzi syndrome is complicated by the presence of inflamed tissue around the hepatic pedicle, making it impossible to distinguish between the main bile duct and the gallbladder. The surgeon's first task is to perform subtotal cholecystotomy (from the fundus of the gallbladder to the neck) without trying to locate the cystic duct. In a second step, the gallstones are extracted and the main bile duct is then repaired. In most cases, a T-tube is used to drain the main bile duct, and abdominal drainage is left in place (in case a bile fistula forms). This study concluded that preoperative drainage of the main bile duct in the treatment of Mirizzi syndrome types II and III is feasible and might help to decrease the postoperative complication rate.
|
|
|
|
|
|
|
|