Surgical Tactics for Mirizzy’s Syndrome

Shavkat I. Karimov¹, MD, ScD; Murad Sh. Khakimov¹, MD, ScD; Farkhad A. Khadjibaev¹, MD, PhD; Fotikh B. Alidjanov³, MD, ScD; Bazarbay K. Altiev², MD, ScD; Sultan O.Tilimisov², MD; Khikmat E. Anvarov², MD

¹Tashkent Medical Academy; ²Republican Research Centre of Emergency Medicine; ³Tashkent Institute of Postgraduate Medical Education; Tashkent, Uzbekistan.

*Corresponding author: Farkhad A. Khadjibaev, MD, PhD. Tashkent Medical Academy Tashkent, Uzbekistan. E-mail:

Published: June 22, 2014.


Surgery performed when there are urgent indications is still the main treatment method for patients with Mirizzi’s syndrome (MS). However, surgical correction often leads to the development of a post-operative stricture of the hepaticocholedoch, which requires complex reconstructive operative interventions at a later time. 93 patients (aged from 27 to 74 years) with MS were treated during 8 years. According to the presence of obstructive jaundice (OJ), the treatment process of the patients was divided into two stages. The first stage started with performing endoscopic diagnostic and operative interventions as retrograde pancreatico-cholangiography (RPCG) with endoscopic papillosphincterotomy (EPCT) and, in cases of inefficiency, the use of percutaneous–transhepatic cholangiostomy (PTChS) was applied. In 39 patients, due to the presence of severe concomitant pathology and high operative risk, the first treatment stage was the final one. Altogether, we operated on 54 patients in the second stage. The results obtained showed that the diagnostic process in patients with gallstones complicated by fistula must be complex, and the leading role should belong to endoscopic means of investigation with high indications of specificity, sensitivity, and general exactness. Operative interventions in patients with MS must be performed in two stages: in the first stage, decompression of the biliary system is performed; in the second stage, adequate bile passage into bowels is recovered.  

Mirizzi’s syndrome; gallstone disease; obstructive jaundice; two-staged surgical treatment; retrograde pancreatico-cholangiography.

1. Gomez D, Rahman SH, Toogood GJ, Prasad KR, Lodge JP, Guillou PJ, et al. Mirizzi's syndrome – results from a large western experience. HPB (Oxford) 2006; 8(6):474-9.

2. Kaya D, Karcaaltincaba M, Akhan O, Uslu N, Haliloglu M. MRCP diagnosis of Mirizzi syndrome in a paediatric patient: importance of TL-weighted gradient echo images for diagnosis. Pediatr Radiol2006; 36(9):980-2.

3. Greyasov VI, Perfil’ev VV, Shchepkin SP, Petrichenko AV, Sivokon' NI, Chuguevskiĭ VM. Diagnostics and surgical tactics for Mirizzi syndrome. Khirirgia (Mosk) 2008;11:31-4. [Article in Russian].

4. Ya.G.Kolkin YaG, Khatsko VV, Dudin AM, Komar EL, Fominov VM. Mirizzi’s syndrome: diagnostics and surgical tactics.  Ukraine Journal of Surgery2012; 2:115-8.

5. Saveliev VS. Mirizzi’s syndrome (diagnostics and treatment).  М.: Medicine; 2003. [Manual in Russian] .

6. Nagakawa T, Ohta T, Kayahara M, Ueno K, Konishi I, Sanada H. A new classification of Mirizzi syndrome from diagnostic and therapeutic viewpoints. Hepatogastroenterology 1997; 44(13):63-7.

7. Yeh CN, Jan YY, Chen MF. Laparoscopic treatment for Mirizzi syndrome. Surg Endosc2003; 17(10):1573-8.

8. Kuleznev YuV, Plyusnin BI, Lyuosev SV, Kapustin VI, Izrailov RE. Advanced technologies in diagnostics and treatment of Mirizzi’s syndrome. Russ Med News2008; 4:61-6. [Article in Russian].

9. Majstrenko NA, Shejko SB, Stukalov VV,  Ratnikov VA, Basos SF, Kazakevich GG, et al. Modern possibilities to diagnose the Mirizzisyndrome (communication 1).  Vestn Khir Im I I Grek 2009; 2:27-33. [Article in Russian].

10. Nazirov FG, Akbarov MM, Nishanov MSh. Mirizzi syndrome diagnostic and treatment.  Khirirgia (Mosk) 2010; 4: 67-73. [Article in Russian].

11. Okhotnikov OI, Yakovleva MV, Grigor’ev SN, Pakhomov VI. Antegrade and endo-biliary interventions in the treatment of complicated gallstone.  Ann Khir Hepatology2013; 1:29-37. [Article in Russian].

The fully formatted PDF version is available.

Download Article

Int J Biomed. 2014; 4(2):85-88. © 2014 International Medical Research and Development Corporation. All rights reserved.