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[Mirizzi syndrome management (in Russian only)].
Khirurgiia (Mosk) 2019; (3):42-47K

Abstract

AIM

To assess an effectiveness of complex preoperative diagnosis, conservative treatment, minimally invasive biliary decompression for Mirizzi syndrome and to analyze surgical outcomes depending on the effectiveness of minimally invasive biliary decompression.

MATERIAL AND METHODS

There were 67 patients with Mirizzi syndrome aged 27-96 years (mean age -64.8 years). The diagnosis was established on the basis of complaints, objective data, laboratory survey, abdominal X-ray, ultrasound (US), endoscopic gastroduodenoscopy (EGDS), computed tomography (CT) and magnetic resonance imaging (MRI). Extrahepatic bile duct visualization in case of suspected biliodigestive fistula was achieved by using of percutaneous transhepatic cholangiography, endoscopic retrograde cholangiopancreatography, cholecystocholangiography, intraoperative cholangiography.

RESULTS

The analysis of the diagnosis and treatment of patients with Mirizzi syndrome and mechanical jaundice with and without symptoms of cholangitis was carried out. It should be noted that percutaneous transhepatic cholangiography and cholecystocholangiography with antegrade contrasting were able to confirm Mirizzi syndrome type 1 without complications. Retrograde cholangiopancreatography in patients with Mirizzi syndrome type 2 reduced the diagnostic value of contrast-enhancement with complications in every fifth patient. Percutaneous drainage for Mirizzi syndrome type 1 was effective in all patients. There was low effectiveness of medication for Mirizzi syndrome. Medication combined with antegrade biliary decompression was 7 times more effective than retrograde decompression. All patients underwent surgery. Mortality depended on surgical emergency and effectiveness of biliary decompression. So, emergency interventions were followed by mortality rate near 60% while there were no deaths after elective procedures. Overall mortality was 11.9%.

Authors+Show Affiliations

Martynov Chair of Hospital-Based Surgery #1, Sechenov First Moscow State Medical University of Ministry of Health of Russia Moscow, Russia, Vorokhobov Munitsipal Clinical Hospital #67 of Moscow Healthcare Department, Moscow, Russia.Martynov Chair of Hospital-Based Surgery #1, Sechenov First Moscow State Medical University of Ministry of Health of Russia Moscow, Russia, Vorokhobov Munitsipal Clinical Hospital #67 of Moscow Healthcare Department, Moscow, Russia.Martynov Chair of Hospital-Based Surgery #1, Sechenov First Moscow State Medical University of Ministry of Health of Russia Moscow, Russia, Vorokhobov Munitsipal Clinical Hospital #67 of Moscow Healthcare Department, Moscow, Russia.Martynov Chair of Hospital-Based Surgery #1, Sechenov First Moscow State Medical University of Ministry of Health of Russia Moscow, Russia, Vorokhobov Munitsipal Clinical Hospital #67 of Moscow Healthcare Department, Moscow, Russia.Martynov Chair of Hospital-Based Surgery #1, Sechenov First Moscow State Medical University of Ministry of Health of Russia Moscow, Russia, Vorokhobov Munitsipal Clinical Hospital #67 of Moscow Healthcare Department, Moscow, Russia.Martynov Chair of Hospital-Based Surgery #1, Sechenov First Moscow State Medical University of Ministry of Health of Russia Moscow, Russia, Vorokhobov Munitsipal Clinical Hospital #67 of Moscow Healthcare Department, Moscow, Russia.Martynov Chair of Hospital-Based Surgery #1, Sechenov First Moscow State Medical University of Ministry of Health of Russia Moscow, Russia, Vorokhobov Munitsipal Clinical Hospital #67 of Moscow Healthcare Department, Moscow, Russia.Martynov Chair of Hospital-Based Surgery #1, Sechenov First Moscow State Medical University of Ministry of Health of Russia Moscow, Russia, Vorokhobov Munitsipal Clinical Hospital #67 of Moscow Healthcare Department, Moscow, Russia.Martynov Chair of Hospital-Based Surgery #1, Sechenov First Moscow State Medical University of Ministry of Health of Russia Moscow, Russia, Vorokhobov Munitsipal Clinical Hospital #67 of Moscow Healthcare Department, Moscow, Russia.

Pub Type(s)

Journal Article

Language

rus

PubMed ID

30938356

Citation

Pugaev, A V., et al. "[Mirizzi Syndrome Management (in Russian Only)]." Khirurgiia, 2019, pp. 42-47.
Pugaev AV, Garaev YA, Alekperov SF, et al. [Mirizzi syndrome management (in Russian only)]. Khirurgiia (Mosk). 2019.
Pugaev, A. V., Garaev, Y. A., Alekperov, S. F., Aleksandrov, L. V., Kalachev, S. V., Achkasov, E. E., ... Kalachev, O. A. (2019). [Mirizzi syndrome management (in Russian only)]. Khirurgiia, (3), pp. 42-47. doi:10.17116/hirurgia201903142.
Pugaev AV, et al. [Mirizzi Syndrome Management (in Russian Only)]. Khirurgiia (Mosk). 2019;(3)42-47. PubMed PMID: 30938356.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Mirizzi syndrome management (in Russian only)]. AU - Pugaev,A V, AU - Garaev,Yu A, AU - Alekperov,S F, AU - Aleksandrov,L V, AU - Kalachev,S V, AU - Achkasov,E E, AU - Posudnevsky,V I, AU - Pugaev,D M, AU - Kalachev,O A, PY - 2019/4/3/entrez PY - 2019/4/3/pubmed PY - 2019/5/31/medline KW - Mirizzi syndrome KW - biliobiliary fistula KW - common bile duct KW - jaundice SP - 42 EP - 47 JF - Khirurgiia JO - Khirurgiia (Mosk) IS - 3 N2 - AIM: To assess an effectiveness of complex preoperative diagnosis, conservative treatment, minimally invasive biliary decompression for Mirizzi syndrome and to analyze surgical outcomes depending on the effectiveness of minimally invasive biliary decompression. MATERIAL AND METHODS: There were 67 patients with Mirizzi syndrome aged 27-96 years (mean age -64.8 years). The diagnosis was established on the basis of complaints, objective data, laboratory survey, abdominal X-ray, ultrasound (US), endoscopic gastroduodenoscopy (EGDS), computed tomography (CT) and magnetic resonance imaging (MRI). Extrahepatic bile duct visualization in case of suspected biliodigestive fistula was achieved by using of percutaneous transhepatic cholangiography, endoscopic retrograde cholangiopancreatography, cholecystocholangiography, intraoperative cholangiography. RESULTS: The analysis of the diagnosis and treatment of patients with Mirizzi syndrome and mechanical jaundice with and without symptoms of cholangitis was carried out. It should be noted that percutaneous transhepatic cholangiography and cholecystocholangiography with antegrade contrasting were able to confirm Mirizzi syndrome type 1 without complications. Retrograde cholangiopancreatography in patients with Mirizzi syndrome type 2 reduced the diagnostic value of contrast-enhancement with complications in every fifth patient. Percutaneous drainage for Mirizzi syndrome type 1 was effective in all patients. There was low effectiveness of medication for Mirizzi syndrome. Medication combined with antegrade biliary decompression was 7 times more effective than retrograde decompression. All patients underwent surgery. Mortality depended on surgical emergency and effectiveness of biliary decompression. So, emergency interventions were followed by mortality rate near 60% while there were no deaths after elective procedures. Overall mortality was 11.9%. SN - 0023-1207 UR - https://www.unboundmedicine.com/medline/citation/30938356/[Mirizzi_syndrome_management_(in_Russian_only)] L2 - https://doi.org/10.17116/hirurgia201903142 DB - PRIME DP - Unbound Medicine ER -