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Systematic Review of Mirizzi's Syndrome's Management

Mallikarjuna Uppara, Ashraf Rasheed

Background Currently various management approaches are described in the literature for Mirizzi's syndrome. But, no clear guidelines for the safe management approach for this rare syndrome. Aim of the Study To conduct a systematic review of management of Mirizzi syndrome. Methods We have conducted a literature search in Medline and Embase data bases using Ovid search engine using the following search terms Mirizzi's syndrome, Mirizzi, Treatment, Laparoscopy, endoscopy, Laparoscopic treatment, endoscopic management and difficult common bile duct stones from 1948 till November 2015. 14 articles met inclusion criteria, dealing with the adopted management approach for both qualitative and quantitative synthesis. We also assessed the outcome of the approach based on the complications and extent of morbidity reported in the literature. Results A total of 425 patient's data from 14 articles were included. Two hundred twelve patients (212) were reported to have type I. Eighty seven patients were reported to have type II. Forty six patients were reported to have type III and above. Eighty patient's data lack the details of the type of Mirizzi's syndrome. One hundred ninety two patients were managed laparoscopic approach. One hundred seventy five patients were managed by open approach. Twenty seven patients were managed by both laparoscopic and open approach. Ten patients by robotic approach. Both endoscopic and laparoscopic approaches were employed in sixteen patients. Five patient’s data were missing for the type of approach employed in the management of Mirizzi's syndrome. The laparoscopic approach was reported to have highest morbidity (40%), open approach was reported to have 16% morbidity. Combined approach (lap converted to open) is reported to have morbidity of 9.26%. Robotic approach is reported to have 0% morbidity. And while the morbidity of the endoscopic and laparoscopic approach varied from 0% to up to 16%, there were no deaths reported in the literature.