Abstract:
Introduction Mirizzi syndrome (MS) 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 cholecystobiliary fistula.
Purpose 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 gallbladder-choledochal
confluence, without fistula formation, cholecystectomy was performed.
Type II-27 (38%) cases, the choledoc (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, CBP drainage type Robson. 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.
Conclusions 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.
Description:
Laboratory of reconstructive surgery of the digestive tract, Department of Surgery No. 2, USMF „Nicolae Testemiţanu”