Skip to main content
SpringerLink
Log in

Single-incision versus four-incision laparoscopic transfistulous bile duct exploration for Mirizzi syndrome type II

  • Dynamic Manuscript
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

We developed laparoscopic transfistulous bile duct exploration (LTBDE) for Mirizzi syndrome (MS) McSherry type II in September 2011. Then, single-incision LTBDE (SILTBDE) was adopted as a preferred technique since August 2013. This retrospective study aims to analyze the outcome of LTBDE in 7.7 years and to compare SILTBDE with four-incision LTBDE (4ILTBDE).

Methods

Seventeen consecutive patients underwent LTBDE for MS McSherry type II from September 2011 to May 2019. Transfistulous removal of the impacted stone(s), choledochoscopic bile duct exploration, and primary closure of the gallbladder remnant were performed without biliary drainage.

Results

The sex ratio is 12:5 (male: female) with an average age of 39.4 ± 10.3 (24–56) years. Ten patients (58.8%) had their diagnoses of MS established by preoperative imaging. According to the Csendes classification, three type II (17.6%), nine type III (52.9%), and five type IV (29.4%) were identified. The operative time was 264.8 ± 60.3 min (156–358 min). The stone clearance rate was 100%. The postoperative hospital stay was 4.7 ± 1.9 (2–10) days. No procedure was converted to an open operation. Two postoperative transient hyperamylasemia (11.8%) and one superficial wound infection (5.9%) occurred and all recovered well under conservative treatment (Clavien-Dindo grade I). During an average 2.2-year follow-up period, no biliary stricture or stone recurrence occurred. No significant difference exists between the SILTBDE and 4ILTBDE groups. Nevertheless, an insignificant trend of shorter postoperative hospital stay was observed in the former. A diagnosis of MS Csendes type IV implicates prolonged total and postoperative hospital stays (p < 0.01).

Conclusions

LTBDE is safe and efficacious for MS McSherry type II. It provides a simple solution for various types of MS and avoids undesirable complications following bilioenteric anastomosis. SILTBDE is comparable to 4ILTBDE for selected patients. Patients with MS Csendes type IV need more time to recover after surgery.

Graphical abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. McSherry CK, Ferstenberg H, Virshup M (1982) The Mirizzi syndrome: suggested classification and surgical therapy. Surg Gastroenterol 1:219–225

    Google Scholar 

  2. Csendes A, Díaz JC, Burdiles P, Maluenda F, Nava O (1989) Mirizzi syndrome and cholecystobiliary fistula: a unifying classification. Br J Surg 76:1139–1143

    Article  CAS  PubMed  Google Scholar 

  3. Beltrán MA (2012) Mirizzi syndrome: history, current knowledge and proposal of a simplified classification. World J Gastroenterol 18:4639–4650

    Article  PubMed  PubMed Central  Google Scholar 

  4. Chuang SH, Yeh MC, Chang CJ (2016) Laparoscopic transfistulous bile duct exploration for Mirizzi syndrome type II: a simplified standardized technique. Surg Endosc 30:5635–5646

    Article  PubMed  Google Scholar 

  5. Chuang SH, Hung MC, Huang SW, Chou DA, Wu HS (2018) Single-incision laparoscopic common bile duct exploration in 101 consecutive patients: choledochotomy, transcystic, and transfistulous approaches. Surg Endosc 32:485–497

    Article  PubMed  Google Scholar 

  6. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  7. Chuang SH, Chen PH, Chang CM, Tsai YF, Lin CS (2014) Single-incision laparoscopic common bile duct exploration with conventional instruments: an innovative technique and a comparative study. J Gastrointest Surg 18:737–743

    Article  PubMed  Google Scholar 

  8. Beltran MA, Csendes A, Cruces KS (2008) The relationship of Mirizzi syndrome and cholecystoenteric fistula: validation of a modified classification. World J Surg 32:2237–2243

    Article  PubMed  Google Scholar 

  9. Clemente G, Tringali A, De Rose AM, Panettieri E, Murazio M, Nuzzo G, Giuliante F (2018) Mirizzi syndrome: diagnosis and management of a challenging billiary disease. Can J Gastroenterol Hepatol 12:6962090

    Google Scholar 

  10. Gonzalez-Urquijo M, Gil-Galindo G, Rodarte-Shade M (2020) Mirizzi syndrome from type I to Vb: a single center experience. Turk J Surg 36:399–404

    Article  PubMed  PubMed Central  Google Scholar 

  11. Tsuyuguchi T, Sakai Y, Sugiyama H, Ishihara T, Yokosuka O (2011) Long-term follow-up after peroral cholangioscopy-directed lithotripsy in patients with difficult bile duct stones, including Mirizzi syndrome: an analysis of risk factors predicting stone recurrence. Surg Endosc 25:2179–2185

    Article  PubMed  Google Scholar 

  12. Senra F, Navaratne L, Acosta A, Martínez-Isla A (2020) Laparoscopic management of type II Mirizzi syndrome. Surg Endosc 34:2303–2312

    Article  PubMed  PubMed Central  Google Scholar 

  13. Nassar AHM, Nassar MK, Gil IC, Ng HJ, Yehia AM (2021) One-session laparoscopic management of Mirizzi syndrome: feasible and safe in specialist units. Surg Endosc 35:3286–3295

    Article  PubMed  Google Scholar 

  14. Krähenbühl L, Moser JJ, Redaelli C, Seiler Ch, Maurer Ch, Baer HU (1997) A standardized surgical approach for the treatment of Mirizzi syndrome. Dig Surg 14:272–276

    Article  Google Scholar 

  15. Shirah BH, Shirah HA, Albeladi KB (2017) Mirizzi syndrome: necessity for safe approach in dealing with diagnostic and treatment challenges. Ann Hepatobiliary Pancreat Surg 21:122–130

    Article  PubMed  PubMed Central  Google Scholar 

  16. Cui Y, Liu Y, Li Z, Zhao E, Zhang H, Cui N (2012) Appraisal of diagnosis and surgical approach for Mirizzi syndrome. ANZ J Surg 82:708–713

    Article  PubMed  Google Scholar 

  17. Valderrama-Treviño AI, Granados-Romero JJ, Espejel-Deloiza M, Chernitzky-Camaño J, Barrera Mera B, Estrada-Mata AG, Ceballos-Villalva JC, Acuña Campos J, Argüero-Sánchez R (2017) Updates in Mirizzi syndrome. Hepatobiliary Surg Nutr 6:170–178

    Article  PubMed  PubMed Central  Google Scholar 

  18. Chen H, Siwo EA, Khu M, Tian Y (2018) Current trends in the management of Mirizzi syndrome: a review of literature. Medicine (Baltimore) 97:e9691

    Article  Google Scholar 

  19. Zhao J, Fan Y, Wu S (2020) Safety and feasibility of laparoscopic approaches for the management of Mirizzi syndrome: a systematic review. Surg Endosc 34:4717–4726

    Article  PubMed  Google Scholar 

  20. Glauser PM, Käser SA, Berov S, Walensi M, Kuhnt E, Maurer CA (2015) Enlargement of umbilical incision in standard laparoscopic cholecystectomy is frequently necessary: an argument for the single incision approach? Minim Invasive Ther Allied Technol 24:175–180

    Article  PubMed  Google Scholar 

  21. Prasad TL, Kumar A, Sikora SS, Saxena R, Kapoor VK (2006) Mirizzi syndrome and gallbladder cancer. J Hepatobiliary Pancreat Surg 13:323–326

    Article  PubMed  Google Scholar 

  22. Nag HH, Nekarakanti PK (2020) Laparoscopic versus open surgical management of patients with Mirizzi’s syndrome: A comparative study. J Minim Access Surg 16:215–219

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We gratefully acknowledge the obligatory works of Ms. Yi-Chun Liao and Ms. Pei-Yi Wang in assisting with the data collection.

Author information

Authors and Affiliations

  1. Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

    Shu-Hung Chuang, Kung-Kai Kuo, Shih-Chang Chuang, Shen-Nien Wang, Wen-Tsan Chang, Wen-Lung Su, Jian-Wei Huang, Po-Hsuan Wu & Hon-Man Chan

  2. School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Shu-Hung Chuang, Kung-Kai Kuo, Shih-Chang Chuang, Shen-Nien Wang, Wen-Tsan Chang & Hon-Man Chan

  3. Department of Anesthesiology, Hsinchu MacKay Memorial Hospital, No.690, Sec. 2, Guangfu Road, Hsinchu City, Taiwan

    Chi-Hang Kuok

Authors
  1. Shu-Hung Chuang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kung-Kai Kuo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shih-Chang Chuang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shen-Nien Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wen-Tsan Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wen-Lung Su
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jian-Wei Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Po-Hsuan Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hon-Man Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Chi-Hang Kuok
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chi-Hang Kuok.

Ethics declarations

Disclosures

Drs. Shu-Hung Chuang, Kung-Kai Kuo, Shih-Chang Chuang, Shen-Nien Wang, Wen-Tsan Chang, Wen-Lung Su, Jian-Wei Huang, Po-Hsuan Wu, Hon-Man Chan, and Chi-Hang Kuok have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 Video 1 Patient No. 14 (a 36-year-old man) was suspected to have Mirizzi syndrome (MS) McSherry type II by preoperative sonography and computed tomography. Low and posterior insertion of cystic duct and MS Csendes type III was confirmed by the intraoperative cholangiography and choledochoscopy. The impacted bile duct stone was successfully extracted during a single-incision laparoscopic transfistulous bile duct exploration. (WMV 152896 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chuang, SH., Kuo, KK., Chuang, SC. et al. Single-incision versus four-incision laparoscopic transfistulous bile duct exploration for Mirizzi syndrome type II. Surg Endosc 36, 8672–8683 (2022). https://doi.org/10.1007/s00464-022-09369-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-022-09369-6

Keywords

Search

Navigation