Application of laparoscopic and endoscopic procedures in patients with Csendes I Mirizzi Syndrome: report of 11 cases

Abstract

Objective To evaluate laparoscopic and endoscopic procedures in individualized diagnosis and therapy of Mirizzi Syndrome(Csendes Type I). Methods Retrospective study was carried out in 900 patients undergoing laparoscopic cholecystectomy(LC) from Nov. 2013 to Dec. 2015. Magnetic cholangiopancreatography(MRCP) and Endoscopic retrograde cholangiopancreatography(ERCP) were done in 24 cases(24/900, 2.7%) for the following reasons: cholecystitis with history of jaundice; abnormal bilirubin showed by serum chemical study; gallbladder stone(s) and enlargement(>0.8 cm) of intrahepatic or extrahepatic biliary tract by ultrasound. According the criteria of MS, 24 cases were diagnosed and 11 of them were type 1 MS(Csendes classification), whose clinical data were analyzed retrospectively. Results All of the 11 cases underwent LC 3-7 days after ERCP, whose stones were removed and bile duct drained by ENBD. Only one case was converted laparotomy because of incarcerated cystic duct stones, which were be shattered and removed under choledochoscopy. Among the 11 cases, 6 were Csendes Ia(3 with secondary common bile duct stone, 2 with acute cholangitis) and 5 were Csendes Ib(2 with secondary common bile duct stone, 1 with acute cholangitis). Conclusions Suspected patients with MS should be performed with MRCP and ERCP and classified with Csendes classification(1989, 2008) for evaluating damage of extrahepatic biliary tract and choice of therapeutic strategy. Csendes Ia and Ib can be operated under laparoscopy, but stones in cystic duct should be explored and extracted after lithotripsy under choledochoscopy. Free of biliary tract exploration would be beneficial to avoid iatrogenic biliary tract stricture. Key words: Jaundice; Gallbladder Stones; Syndrome; Diagnosis; Laparoscopic; Endoscopic