CURRENT APPROACHES TO DIAGNOSIS AND SURGICAL TREATMENT OF MIRIZZI SYNDROME (OWN CLINICAL OBSERVATIONS WITH LITERATURE REVIEW)

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The article presents the review of the literature and own clinical observations on the diagnosis and surgical treatment of Mirizzi syndrome – a rare complication of gallstones. The clinical features of the disease has no specific symptoms. The main clinical signs of MS are periodic jaundice (84%), pain in the right hypochondrium (75%) and cholangitis (56%), the phenomenon of acute cholecystitis and pancreatitis. The most informative method of preoperative diagnosis is magnetic resonance imaging, which, unfortunately, not readily available for public use. The diagnostic sensitivity of MRI with MS is 97,6%, intraoperative cholangiography – 94%, ERCP – 86%, PTC – 5%, fibrocholangioscopy – 77%, ultrasound – 46%. The most common type of MS (10,5-51%), less often type II (15-41%), even more rare types III (3-44%), IV (7,4%) and V (2,9% ). The leading role in the treatment of syndrome belongs to open surgery. Laparoscopic cholecystectomy can only be shown to individual MS and type I patients. Conversion with this occurs in 31-100%, complications – 60%, damage to common bile duct – 22%. Open cholecystectomy remains the standard. For Type II and III types of MS, they perform cholecystectomy while retaining part of the Hartmann pocket with the subsequent plastics of CBD at the Kehr drainage. At type IV of the MS it is shown a hepaticojejunostomy. Reorder phases of operation including cholangiography before cholecystectomy made it possible to diagnose and set the type of Mirizzi syndrome, to determine the optimal surgery approach and to prevent intra– and postoperative complications.