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Laparoscopic management of a type III Mirizzi syndrome: cholecystectomy with flag technique and ideal suture of a cholecystobiliary fistula
In this video, authors demonstrate the laparoscopic management of a Mirizzi syndrome. Due to a cholecystocholedochal fistula and to a difficult dissection of Calot’s triangle, authors decided to modify the dissection technique by performing a primary freeing of the gallblader as described by Jean Mouiel. In order to prevent any further biliary damage, a subtotal cholecystectomy is also achieved by means of an EndoGia™ linear stapler. Cholecystobiliary fistula is repaired using an absorbable running suture protected by an internal choledochal drain placed thanks to preoperative endoscopic catheterization.
HA Mercoli, L Marx, J Leroy, P Pessaux, J Marescaux
Surgical intervention
5 years ago
5990 views
176 likes
0 comments
07:11
Laparoscopic management of a type III Mirizzi syndrome: cholecystectomy with flag technique and ideal suture of a cholecystobiliary fistula
In this video, authors demonstrate the laparoscopic management of a Mirizzi syndrome. Due to a cholecystocholedochal fistula and to a difficult dissection of Calot’s triangle, authors decided to modify the dissection technique by performing a primary freeing of the gallblader as described by Jean Mouiel. In order to prevent any further biliary damage, a subtotal cholecystectomy is also achieved by means of an EndoGia™ linear stapler. Cholecystobiliary fistula is repaired using an absorbable running suture protected by an internal choledochal drain placed thanks to preoperative endoscopic catheterization.
Subtotal laparoscopic cholecystectomy for Mirizzi syndrome type IA
This video shows a case of Mirizzi syndrome type IA (according to the classification of Csendes and Nagakava). This 36-year-old female patient was admitted for an elective laparoscopic cholecystectomy due to a chronic calculous cholecystitis. Preoperative examination did not reveal any peculiarities. Patient set-up and trocar placement were conventional and unremarkable. During the operation, anatomical abnormalities of Calot’s triangle were observed -- namely common bile duct and other elements of the neck of gallbladder were not differentiated. The common bile duct was firstly adopted as the cystic duct, giving the impression that it falls into the gallbladder. In addition, it was impossible to visualize the proximal part of the common bile duct. After several long attempts at dissection, the cystic duct failed to show. We then opened the lumen of the gallbladder accidentally, which revealed the inner opening of the cystic duct. We used it as a landmark to dissect the stump of the cystic duct. Three Endoclips were applied onto the stump of the duct. The free wall of the gallbladder was excised. The remaining mucosa of the gallbladder was carefully coagulated.
In relation to such changes, the diagnosis of chronic calculous cholecystitis, Mirizzi syndrome type IA was established.
A Sazhin, S Mosin
Surgical intervention
5 years ago
4799 views
128 likes
0 comments
14:44
Subtotal laparoscopic cholecystectomy for Mirizzi syndrome type IA
This video shows a case of Mirizzi syndrome type IA (according to the classification of Csendes and Nagakava). This 36-year-old female patient was admitted for an elective laparoscopic cholecystectomy due to a chronic calculous cholecystitis. Preoperative examination did not reveal any peculiarities. Patient set-up and trocar placement were conventional and unremarkable. During the operation, anatomical abnormalities of Calot’s triangle were observed -- namely common bile duct and other elements of the neck of gallbladder were not differentiated. The common bile duct was firstly adopted as the cystic duct, giving the impression that it falls into the gallbladder. In addition, it was impossible to visualize the proximal part of the common bile duct. After several long attempts at dissection, the cystic duct failed to show. We then opened the lumen of the gallbladder accidentally, which revealed the inner opening of the cystic duct. We used it as a landmark to dissect the stump of the cystic duct. Three Endoclips were applied onto the stump of the duct. The free wall of the gallbladder was excised. The remaining mucosa of the gallbladder was carefully coagulated.
In relation to such changes, the diagnosis of chronic calculous cholecystitis, Mirizzi syndrome type IA was established.