MINIMALLY INVASIVE MANAGEMENT OF MIRIZZI SYNDROME. SERIES OF 12 CASES.
Adolfo Cuendis Velazquez, Roberto A. Garcia Manzano, Karina Flores Marín, Roberto Delano-Alonso*, Jose J. Herrera-Esquivel, Mucio Moreno Portillo
Endoscopia Gastrointestinal, Hospital General Dr Manuel Gea Gonzalez, Ciudad de Mexico, Ciudad de México, Mexico
INTRODUCTION
Minimally invasive treatment of Mirizzi syndrome is feasible and safe when performed by surgeons experienced in the management of this pathology. Laparoscopy, robotic assistance, and choledochoscopy can be combined with novel approaches and techniques to increase the likelihood of treatment success in reconstructing the anatomy by recruiting the infundibular part of the fistula.
OBJECTIVE
Demonstrate that laparoscopy, robotic assistance and choledochoscopy can be combined with novel approaches and techniques to increase the probability of successful treatment in this pathology.
MATERIAL AND METHODS
A retrospective, cross-sectional, descriptive study was conducted in which 11 records of patients with a diagnosis of Mirizzi Syndrome corroborated by intraoperative cholangiography and ERCP were reviewed, who underwent laparoscopic treatment in the period from January 2018 to January 2020 in a second-level hospital. Demographic variables were analyzed (sex, age, comorbidities, clinical presentation and initial liver function tests), variables regarding diagnosis and previous endoscopic management with ERCP, the type of laparoscopic management and trans-surgical variables (surgical technique, surgical time, bleeding) were described. intraoperative). Descriptive statistics and measures of central tendency were used.
RESULTS
The average age was 53 years, 8 of the patients (66.6%) were women. 100% of the patients presented cholestasis as the initial condition, 2 of them with the presence of organic failure (1 patient for grade III cholangitis and the second for presenting severe SIRA due to SARS COV-2). Of the 12 patients, 3 (25%) presented cholangitis (1 patient grade III cholangitis and 2 grade I), the rest were diagnosed as acute chronic cholecystitis with a high risk of choledocholithiasis at the time of admission. 11 patients (91.6%) underwent ERCP before surgery, with stent placement (in the patient with SARS COV-2, the procedure was deferred due to current hemodynamic status). By ERCP, Mirizzi syndrome was diagnosed in 100% of the patients who underwent the procedure, with sphincterotomy therapy, plus endoprosthesis placement. In one patient, basket lithotripsy was performed. 91.6% of the patients had a laparoscopic surgical approach with conventional trocar placement for 3-port cholecystectomy, 1 patient was approached with robot assistance (Da Vinci system). The mean surgical time was 181 minutes, mean bleeding 197 cc. 100% therapeutic success.
There were no complications attributable to the laparoscopic procedure.
CONCLUSION
Minimally invasive treatment (laparoscopic, robotic) is a safe and feasible technique when performed by experienced surgeons. It provides the advantages of laparoscopy in terms of postoperative results with reduced morbidity and a shorter hospital stay, while providing adequate treatment for this condition.
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