Treatment of Mirizzi syndrome using ERCP and ENBD combined with laparoscopic surgery

Abstract

Objective To study the combined used of endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic surgery in the treatment of Mirizzi syndrome and in the prevention of bile duct injury in minimally invasive surgery. Methods A retrospective analysis was conducted on patients who suffered from Mirizzi syndrome treated with ERCP and laparoscopic surgery from March 2011 to February 2016 at the Center Hospital of Xianyang City, Southern Medical University. Results Of 1762 patients who underwent ERCP, 56 patients were diagnosed to suffer from Mirizzi syndrome (3.2%). Thirty-six patients with type Ⅰ disease successfully completed LC. The adjacent tissues were used to repair the defects in the first stage for type Ⅱ disease in 12 patients and for type Ⅲ disease in 4 patients. T tube was not used. The bile was drained with a ENBD drainage tube. After LC, a bile duct to jejunum Roux-en-Y anastomosis was carried out for the type Ⅱ disease in 2 patients and for the type Ⅲ disease in 2 patients. There was no perioperative death for the whole group of patients. Two patients developed symptoms of cholangitis, and the disease was stable after non-operative treatment. For the other patients, follow-up for more than 2 years showed good results. Conclusions ERCP was useful in the diagnosis of Mirizzi syndrome and in the Csendes typing before operation. ENBD could be used as a guide to find the hepatic duct, thus avoiding bile duct injury during laparoscopic surgery and for the placement of T tube drainage. ERCP combined with laparoscopic surgery in the treatment of Mirizzi syndrome was safe and effective. It is an operation which has the advantage of minimal trauma, less pain and rapid recovery. Key words: Mirizzi syndrome (MS); Endoscopic retrograde cholangio pancreatography (ERCP); Endoscopic nasal biliary drainage (ENBD); Laparoscope surgery; Cholecystectomy; Bile duct injury