Treatment of Mirizzi syndrome
DOI:
https://doi.org/10.11603/2414-4533.2019.2.10411Keywords:
Mirizzi syndrome, choledocholithiasis, spontaneous internal biliary fistulaAbstract
The aim of the work: determination of the method of surgical treatment of spontaneous internal biliary fistulas (SIBF) in Mirizzi syndrome.
Materials and Methods. A retrospective analysis of results of the treatment of 8200 patients with cholelithiasis in regional Andrii Novak Hospital from 1997 to 2018. Among them, 199 patients were observed with SIBF. The frequency with which the SIBF occurred was 2.4 %.
Results and Discussion. Patients with MS type 1 underwent cholecystectomy with sewing of the wide and short bladder duct. In 30 patients with MS type 2, cholecystectomy was performed from the bottom with the incision of the fistula and the sewing of the defect in the common bile duct (CBD) on a T-tube. In 14 patients with MS type 3, the choice was cholecystectomy with plastic surgery with the remnants of the wall of the gallbladder and external drainage of the T-tube. 9 patients with Mirizzi syndrome type 4 underwent cholecystectomy “from the bottom” with a complete intersection of CBD. Nineteen patients with choledocho-duodenal fistulae type I were performed endoscopic papillofystulotomy for the purpose of reliable drainage of CBD, evacuation of concrements from it, and elimination of the intrathoracic fistula opening. The purpose of the operation in spontaneous internal biliary fistula is to remove the gallbladder, to ensure the flow of bile into the lumen of the digestive tube and the chyme passage on it. In the presence of a fistula in the digestive organ, its incision is performed with hole sewing, in some cases resection methods for the elimination of the fistula.
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