Laparoscopic transfistulous bile duct exploration for Mirizzi syndrome type II: a simplified standardized technique
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Laparoscopic treatment is a viable option for Mirizzi syndrome (MS) type I, but it is not recommended for MS type II (McSherry classification). We introduce laparoscopic transfistulous bile duct exploration (LTBDE) as a simplified standardized technique for MS type II.
Eleven consecutive LTBDEs performed by a surgeon for MS type II were analyzed retrospectively, including three successful single-incision LTBDEs (SILTBDEs). Transfistulous stone removal followed by primary closure of gallbladder remnant and partial cholecystectomy was performed. An additional choledochotomy was required in one patient.
Preoperative endoscopic retrograde cholangiopancreatography and operative findings confirmed the diagnosis of MS in five and five patients, respectively. Preoperative ultrasound implied the remaining diagnosis. The operative time was 270.5 ± 65.5 min. The stone clearance rate was 100 %. The postoperative length of hospital stay was 5.1 ± 2.2 days. There was no open conversion. Overall complications comprised two postoperative transient hyperamylasemia (18.2 %) and one superficial wound infection (9.1 %). Compared with the other group of 92 patients who underwent laparoscopic bile duct exploration, the MS type II group had a significantly younger age, a higher jaundice rate, a lower single-incision laparoscopic approach rate, a lower choledochotomy rate, longer operative time, a lower postoperative pethidine dose, and a longer total length of hospital stay. The average follow-up period was 12.1 months.
LTBDE is safe and efficacious for MS type II including Csendes type IV. A high suspicion of MS is critical. SILTBDE is feasible in selected cases. Long-term follow-up is mandatory.
KeywordsCholedochotomy Cystocholedochal Infundibulotomy Laparoscopic bile duct exploration Mirizzi syndrome Single-incision laparoscopic surgery Transfistulous
We gratefully acknowledge the obligatory works of Ms. Yi-Chun Liao and Ms. Pei-Yi Wang in assisting with the data collection.
Compliance with ethical standards
Drs. Shu-Hung Chuang, Meng-Ching Yeh, and Chien-Jen Chang have no conflicts of interest or financial ties to disclose.
Standard four-incision laparoscopic transfistulous bile duct exploration in patient No. 5. The diagnosis of Csendes type IV was confirmed by intraoperative findings and completion cholangiogram. A 2-cm stone impacted at cystocholedochal junction was crushed and extracted with a grasper (WMV 209529 kb)
Single-incision laparoscopic transfistulous bile duct exploration and partial cholecystectomy in patient No. 9. Cystic duct anomaly of parallel course with low and anterior insertion and the diagnosis of Csendes type III were identified by diagnostic and completion cholangiograms. A 0.8-cm stone impacted at cystocholedochal junction was loosened and extracted with a basket (WMV 125451 kb)
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