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- Title
Laparoscopic transfistulous bile duct exploration for Mirizzi syndrome type II: a simplified standardized technique.
- Authors
Chuang, Shu-Hung; Yeh, Meng-Ching; Chang, Chien-Jen
- Abstract
<bold>Background: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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.
- Subjects
LAPAROSCOPIC surgery; BILE duct surgery; ENDOSCOPIC retrograde cholangiopancreatography; OPERATIVE surgery; BILIARY tract; GALLSTONE diagnosis; MIRIZZI syndrome; LENGTH of stay in hospitals; GALLSTONES; RETROSPECTIVE studies; CHOLECYSTECTOMY; BILIARY tract surgery
- Publication
Surgical Endoscopy & Other Interventional Techniques, 2016, Vol 30, Issue 12, p5635
- ISSN
1866-6817
- Publication type
journal article
- DOI
10.1007/s00464-016-4911-0