Particulars of diagnosis and surgical treatment of patients with Mirizzi syndrome

Abstract

Background: Mirizzi syndrome (SM) is a late and rare complication in the evolution of gallstones, morphologically translated by compression of the hepato-choledochus with stricture formation at this level or cholecysto-biliary fistula. Objective of the study. Evaluation of the particularities of diagnosis and surgical treatment of patients with Mirizzi Syndrome. Material and Methods. The study group included 71 patients with MS treated in the clinic during the years 2000-2021. The age range between 24 and 91 years, the distribution by gender being: 57 (80.3%) women and 14 (19.7%) men. Instrumental diagnosis used: USG performed in all cases, ERCP-68 (95.7%) cases, MRCP-17 (23.9%) cases, CT with contrast-12 (16.9%) cases. Results.The treatment was exclusively surgical, adapted to the type of MS. Type I-16 (22.5%) cases with attestation of a vesico-choledochal confluence, without fistula formation, cholecystectomy was performed. Type II-27 (38%) cases, the CBP parietal defect was less than 1/3 of its diameter, the interventions ended with the plasty of the CBP defect on the Kehr drainage. Type III-18 (25.3%) cases, CBP defect was 2/3 of the diameter, CBP plasty was performed with vascularized flap from the gallbladder, Robson type CBP drainage. Type IV-10 (19.23%) cases, the parietal defect was over 67% of the CBP diameter, choledocholithotomy was performed with hepaticojejunoanastomosis on the Roux loop. Conclusion. Prevalence of type II SM. The anatomical variety of SM requires the application of sophisticated imaging methods, which allows increasing the rate of preoperative diagnosis. Surgical treatment includes a multitude of surgical techniques and will depend on the type of SM.

Introducere. Sindromul Mirizzi (SM) reprezintă o complicaţie tardivă şi rar întâlnită în evoluţia litiazei biliare, morfologic tradusă prin compresia hepato-coledocului cu formare de strictură la acest nivel sau fistulă colecisto-biliară. Scopul lucrării.Evaluarea particularităților de diagnostic și tratament chirurgical al pacienților cu Sindrom Mirizzi. Material și Metode. Lotul de studiu a inclus 71 pacienți cu SM, tratați în clinică pe parcursul anilor 2000-2021. Intervalul de vârstă între limitele de la 24 până la 91 ani, repartizarea după gen fiind: 57(80.3%) femei și 14(19.7%) bărbați. Diagnosticul instrumental utilizat: USG efectuat în toate cazurile, ERCP-68(95,7%) cazuri, MRCP-17(23,9%) cazuri, CT cu contrast-12(16,9%) cazuri. Rezultate. Tratamentul a fost exclusiv chirurgical, adaptat tipului de SM. Tip I-16(22,5%) cazuri cu atestarea unei confluenţe vezico-coledociene, fără formarea fistulei, a fost efectuat colecistectomia. Tip II-27(38%) cazuri, defectul parietal CBP a fost sub 1/3 din diametrul lui, intervenţiile s-au finisat cu plastia defectului CBP pe drenajul Kehr. Tip III-18(25,3%) cazuri, defectul CBP a constituit 2/3 din diametru, s-a efectuat plastia CBP cu lambou vascularizat din vezicula biliară, drenarea CBP tip Robson. Tip IV-10(19,23%) cazuri, defectul parietal a fost de peste 67% din diametrul CBP, s-a efectuat coledocolitotomie cu hepaticojejunoanastomoză pe ansa Roux. Concluzii. Prevalarea tipului II de SM. Varietatea anatomică a SM necesită aplicarea metodelor imagistice sofisticate, care permit creșterea ratei stabilirii diagnosticului preoperator. Tratamentul chirurgical include o multitudine de tehnici chirurgicale și va fi în funcţie de tipul SM.