Surgical Treatment of Mirizzi’s Syndrome

Among the etiological factors in the development of complications of gallstone disease, Mirizzi's syndrome has particular importance. In the surgical treatment of patients with Mirizzi's syndrome, minimally invasive and open surgical interventions are used. In the modern era of minimal invasive surgical technologies, the problem of expanding the use of such interventions in the Mirizzi's syndrome is really problematic to reduce surgical trauma and improve the results of surgical treatment. The purpose of the study was the development and implementation of tactics for the use of minimally invasive surgical interventions in the Mirizzi's syndrome. Materials and methods. This study presents the results of treating 51 patients with Mirizzi's syndrome. Among these patients, mechanical jaundice was in 43 patients (84,3%), acute cholangitis – in 35 (68,6%) patients. A significant number of patients were hospitalized within a period of more than 7 days from the onset of clinical manifestations of the lesion of the bile duct system – 29 (56,9%) patients. The duration of mechanical jaundice ranged from 1 to 31 days (average 14.5 ± 1.4 days). Results and Discussion. In the pre-operative period, Mirizzi's syndrome was diagnosed in 27 (52,9%) patients. In the presence of mechanical jaundice and purulent cholangitis surgical treatment was carried out in several stages. In the first stage, we treated 10 patients, in the second stage – 35 patients, in the third stage – 6 patients. We proposed approaches for the wider use of minimally invasive interventions in Mirizzi's syndrome, which would reduce the traumatism of surgical treatment. A total of 51 patients with Mirizzi's syndrome performed 71 interventions: endoscopic papillosphincterotomy (EPST) – 41 (including 10 lithotripsy and lioextraction); laparoscopic cholecystectomy – 17 (including, with drainage of hepathicocholedoch – 6, plastics of hepaticocholedoch on drainage – 5); 32 – open surgical interventions with cholecystectomy and plastic defect of hepaticocholedoch in drainage in 13 cases, and overlaying of a biliodigestive anastomosis in 6 patients. Conclusions. Transduodenal endoscopic interventions have low efficacy in Mirizzi's syndrome, since endoscopic lithotripsy and lithoextraction in Mirizzi's syndrome are impossible in most cases due to the large size of gallstones. The implementation of laparoscopic surgery in Mirizzi's syndrome requires a lot of time, has significant difficulties in performing due to pathological changes in the anatomy of the relationship between the elements of hepatoduodenal ligament and the high probability of complications of surgical intervention because of damage to the biliary tract and vessels. Mirizzi's syndrome most often causes conversion during laparoscopic surgery. Most often, in the surgical treatment of patients with Mirizzi's syndrome, it is possible to close the defect of hepaticochledoch with the use of local tissues and the "patch" from the bladder duct or the wall of the gall bladder. Large volume of hepaticohledoch destruction usually more than half the circumference forces to use hepaticojejunoanastomosis. Prospects for further research: improving the treatment of patients with mechanical jaundice and cholangitis.