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Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea

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Surgical Treatm ent of M irizzi Syndrom e

M inSung Chung, M.D., KiHun Kim , M.D., YoungJoo Lee, M.D., KwangM in Park, M.D., Shin Hw ang, M.D., ChulSoo Ahn, M.D., DeokBog M oon, M.D., ChongW oo Chu, M.D., HyunSeung Yang, M.D., TaeYong Ha, M.D., SungHoon Cho, M.D., KiBong Oh, M.D.

and SungGyu Lee, M.D.

Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea

Background/Aims: Mirizzi syndrome is a rare complication of longstanding gallstone disease which resulting in obstruc- tive Jaundice. It is benign stricture of common hepatic duct because of stone impacted with in the cystic duct or Hart- mann pouch of the gallbladder. The aim of this study is to evaluate our experience of Mirizzi syndrome and consider its surgical treatment.

Methods: During the years 1994 to 2001 at Asan medical center, 23 cases of Mirizzi syndrome were diagnosed on the basis of preoperative and postoperative findings and they were retrospectively reviewed.

Results: There were 12 patients with Csendes type I, 6 pa-

tients with type II, and 5 patients with Type III. Average age was 61 years (range: 31 to 83 years) For preoperative evaluation Endoscopic retrograde cholangiopancreatography (ERCP) and Ultrasonography were performed in all cases.

Laparoscopic cholecystectomy was tried in 7 type I cases.

5 were successfully treated and 2 conversions were reported, all because of unclear anatomy. In 6 type II cases open cholecystrctomy, CHD repair and T tube insertion were per- formed. 5 patients with type III were required hepaticojejuno- stomy.

Conclusions: High index of suspicion is required for diag- nosis of Mirizzi syndrome and laparoscopic approach is permissible in specialized center especially in the case of suspected Mirizzi type I, under the recognition of biliary anatomy through preoperative imaging studies. If there is fistula or unclear anatomy, we recommend open operative techniques for the safety and the efficiency. (Korean J HBP Surg 2002;6:89-93)

Key Words: Mirizzi syndrome, Cholecystobiliary fistula, Lapa- roscopic cholecystectomy

: Mirizzi , ,

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