Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2022; 14(2): 107-119
Published online Feb 27, 2022. doi: 10.4240/wjgs.v14.i2.107
Surgical strategies for Mirizzi syndrome: A ten-year single center experience
Wei Lai, Jie Yang, Nan Xu, Jun-Hua Chen, Chen Yang, Hui-Hua Yao
Wei Lai, Jie Yang, Nan Xu, Jun-Hua Chen, Chen Yang, Hui-Hua Yao, Department of Hepatobiliary-Pancreatic-Splenic Surgery, Chengdu First People’s Hospital (Chengdu Integrated TCM & Western Medicine Hospital), Chengdu 610044, Sichuan Province, China
Author contributions: Lai W designed the research protocol, wrote the paper analyzed the data, reviewed and revised the paper; Lai W, Yang J, Xu N, Chen JH, Yang C and Yao HH conducted the research and analyses; all authors have read and approved the final version to be submitted.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Chengdu First People’s Hospital(Chengdu Integrated TCM & Western Medicine Hospital).
Informed consent statement: Due to the retrospective design of the study, informed consent was waived by the ethics committee for this study.
Conflict-of-interest statement: The authors have no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei Lai, MD, Associate Professor, Attending Doctor, Department of Hepatobiliary-Pancreatic-Splenic Surgery, Chengdu First People’s Hospital (Chengdu Integrated TCM & Western Medicine Hospital), No. 18 Wanxiang North Road, High Tech District, Chengdu 610044, Sichuan Province, China. laiwei119@163.com
Received: September 3, 2021
Peer-review started: September 3, 2021
First decision: October 2, 2021
Revised: October 13, 2021
Accepted: January 14, 2022
Article in press: January 14, 2022
Published online: February 27, 2022
ARTICLE HIGHLIGHTS
Research background

Mirizzi syndrome (MS) has always been a challenge for surgeons and an important cause of bile duct injury (BDI). At present, this problem has still not been resolved. If we do not accurately understand the pathological characteristics and potential surgical risks of MS, this may lead to adverse clinical consequences.

Research motivation

The treatment methods and effects for MS are changeable according to the different classification types, and the risks are also variable. Whether laparoscopic surgery is suitable for the treatment of MS is also controversial.

Research objectives

This study is a retrospective analysis using data accumulated over a decade that aimed to summarize preoperative diagnostic methods and the safety, effectiveness, prognosis and related factors of surgical strategies including laparoscopic surgery for different types of MS.

Research methods

Sixty-six patients who met the inclusion criteria were included in the study. The diagnostic methods, clinical classification, surgical approach, complications and long-term prognosis were analyzed.

Research results

Magnetic resonance imaging/magnetic resonance cholangiopancreatography (MRI/MRCP) is superior to ultrasound scan in the diagnosis of MS. The overall laparoscopic surgery completion rate was 53.03% (35/66). Thirty-one patients (46.97%, 31/66) underwent laparotomy or conversion to laparotomy, including 11 cases of iatrogenic BDI which occurred in type I patients. Overall, 35 patients (53.03%, 35/66) needed bile duct repair using different methods. Twenty-five patients underwent intraoperative choledochoscopy and T-tube cholangiography. A total of 66 patients obtained a relatively high preoperative diagnosis rate and underwent surgery safely without serious complications and no mortality was observed during the follow-up period.

Research conclusions

MRI/MRCP can improve the preoperative diagnosis rate of MS. Laparoscopic surgery can be undertaken safely in some patients with MS, especially Csendes type I and type II patients, and the surgical technique should be carefully determined for Csendes type III patients. The Csendes classification can reflect treatment difficulty and was related to the length of hospital stay and cost. The risk to patients due to a change in Csendes classification caused by iatrogenic injury during surgery should be avoided.

Research perspectives

Sixty-six patients completed diagnostic and treatment procedures by different medical groups within 10 years, which may have led to significant heterogeneity. Accurate conclusions should be confirmed by further large sample prospective studies.