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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
4786 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.
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
5977 views
175 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.
Endoscopic extraction of a giant cystic duct stone to treat type I Mirizzi syndrome
Mirizzi syndrome (MS) is characterized by common hepatic duct obstruction due to mechanical compression and surrounding inflammation by a gallstone impacted in the cystic duct (type I) or at the gallbladder neck (type II). Preoperative diagnosis of the syndrome is mandatory and associated with a decrease of complication rate of surgical management. Endoscopic therapies like ERCP with lithotripsy or endoscopic extraction of cystic duct calculi followed by laparoscopic cholecystectomy have been described. Here we report successful endoscopic stone-clearance using double-cannulation and large balloon dilatation of the papilla for giant biliary stone impacted in the cystic duct inserted low in the common hepatic duct causing type I MS.
Bibliographic reference:
Double-cannulation and large papillary balloon dilation: key to successful endoscopic treatment of mirizzi syndrome in low insertion of cystic duct. Donatelli G, Dhumane P, Dallemagne B, Marx L, Delvaux M, Gay G, Marescaux J. Dig Endosc 2012;24:466-9.
Gf Donatelli, P Dhumane, S Perretta, BM Vergeau, JL Dumont, T Tuszynski, B Meduri
Surgical intervention
5 years ago
891 views
13 likes
0 comments
04:09
Endoscopic extraction of a giant cystic duct stone to treat type I Mirizzi syndrome
Mirizzi syndrome (MS) is characterized by common hepatic duct obstruction due to mechanical compression and surrounding inflammation by a gallstone impacted in the cystic duct (type I) or at the gallbladder neck (type II). Preoperative diagnosis of the syndrome is mandatory and associated with a decrease of complication rate of surgical management. Endoscopic therapies like ERCP with lithotripsy or endoscopic extraction of cystic duct calculi followed by laparoscopic cholecystectomy have been described. Here we report successful endoscopic stone-clearance using double-cannulation and large balloon dilatation of the papilla for giant biliary stone impacted in the cystic duct inserted low in the common hepatic duct causing type I MS.
Bibliographic reference:
Double-cannulation and large papillary balloon dilation: key to successful endoscopic treatment of mirizzi syndrome in low insertion of cystic duct. Donatelli G, Dhumane P, Dallemagne B, Marx L, Delvaux M, Gay G, Marescaux J. Dig Endosc 2012;24:466-9.
Laparoscopic management of Mirizzi syndrome
The surgical management of acute cholecystitis continues to be a matter of personal choice. At our institution, we perform early laparoscopic cholecystectomy electively after treatment with intravenous fluids and antibiotics.
We present the case of a 35-year-old man who was admitted with a history of pain in the right upper abdomen for one day. He was managed with analgesics, intravenous fluids, and antibiotics. Despite relief from pain with aggressive medical therapy, he developed jaundice. An ultrasound examination confirmed a small stone impacted in the neck of the gallbladder and non-dilated biliary radicles. In view of increased serum bilirubin, the patient was scheduled for laparoscopic cholecystectomy.
Laparoscopic cholecystectomy revealed a gangrenous gallbladder with dilated cystic and common bile ducts. Intraoperative cholangiogram showed a suspicious filling defect at the lower end of the common bile duct. The ureteric catheter was therefore left indwelling and removed after one month.
Aa Rai, R Singh, S Rai, Sa Rai
Surgical intervention
6 years ago
6278 views
102 likes
0 comments
16:58
Laparoscopic management of Mirizzi syndrome
The surgical management of acute cholecystitis continues to be a matter of personal choice. At our institution, we perform early laparoscopic cholecystectomy electively after treatment with intravenous fluids and antibiotics.
We present the case of a 35-year-old man who was admitted with a history of pain in the right upper abdomen for one day. He was managed with analgesics, intravenous fluids, and antibiotics. Despite relief from pain with aggressive medical therapy, he developed jaundice. An ultrasound examination confirmed a small stone impacted in the neck of the gallbladder and non-dilated biliary radicles. In view of increased serum bilirubin, the patient was scheduled for laparoscopic cholecystectomy.
Laparoscopic cholecystectomy revealed a gangrenous gallbladder with dilated cystic and common bile ducts. Intraoperative cholangiogram showed a suspicious filling defect at the lower end of the common bile duct. The ureteric catheter was therefore left indwelling and removed after one month.