Mirizzi syndrome- how to manage?

[Aparshakti]

Hello, a 51-year-old woman presented with jaundice alongside a weight loss of 6 kg over the previous two weeks. She had no other symptoms, besides jaundice. A gallbladder ultrasound showed multiple echogenic foci in the gallbladder consistent with cholelithiasis and intrahepatic biliary channel and choledochal duct dilation. An ERCP did not show an obvious common bile duct stone but did show a stricture in the common hepatic duct suggestive of cholangiocarcinoma. The patient was therefore placed on the list for the surgical intervention 1 month after her initial presentation of symptoms and Bismuth type II cholangiocarcinoma diagnosis. During surgery, the abdominal cavity was accessed via a J incision, and no secondary peritoneal malignancy was seen. How to manage this mirizzi syndrome?

[Bishwajit]

@aparshakti Mirizzi Syndrome is a rare and challenging clinical entity to manage. However, recent advances in technology have provided surgeons with new options for more effective diagnosis and treatment of this condition. Surgery remains the preferred approach for the treatment of Mirizzi Syndrome. Laparoscopic cholecystectomy (LC), which has been used since 1987, was first reported to successfully treat Type 1 Mirizzi Syndrome by Paul et al. However, most surgeons do not recommend LC as a viable standard of treatment due to the increased risk of bile duct injury and a high conversion rate with this condition. In the papers we reviewed, open surgery was still the favorite treatment modality, accounting for 40% to 100% of cases. One systematic review, by Antoniou et al, associated laparoscopic treatment for Mirizzi Syndrome with low success rates; consequently, these authors did not recommend this technique. Despite these setbacks, minimally-invasive techniques in the management of Mirizzi Syndrome continue to be explored, albeit with limited application. Some treatment modalities, such as endoscopic and robotic-assisted techniques, are beginning to show preference with some authors.