Mirizzi Syndrome and Its Management

Mirizzi syndrome is an uncommon complication of chronic gallstone disease, characterized by the impaction of a gallstone into the gallbladder neck or cystic duct, leading to bile duct obstruction and potential fistula formation. This condition, first described by Pablo Luis Mirizzi, results from external compression of the bile duct due to gallstone impaction, often accompanied by inflammation, fibrosis, and tissue necrosis. The syndrome is divided into various types on the basis of the presence and severity of cholecystobiliary or cholecystoenteric fistulas, with type I involving external compression and types II–V involving fistula formation. Clinically, Mirizzi syndrome presents with symptoms such as right upper quadrant pain, fever, and jaundice, though the classic triad is seen in only 44–71% of cases. The diagnosis relies on imaging modalities, including ultrasonography, CT, magnetic resonance cholangiopancreatography (MRCP), and endoscopic retrograde cholangiopancreatography (ERCP), with ERCP being the gold standard despite its invasiveness. Surgical management remains the primary treatment, with open cholecystectomy traditionally preferred. However, laparoscopic and robot-assisted techniques combined with endoscopic techniques are increasingly utilized, particularly for complex cases, offering minimally invasive options with improved outcomes. Endoscopic interventions, such as ERCP, play a complementary role, especially in preoperative biliary decompression or stone extraction. Despite advancements in diagnostic and therapeutic techniques, Mirizzi syndrome is often diagnosed intraoperatively, underscoring the need for surgical expertise and a multidisciplinary approach. Tailored management strategies, including subtotal cholecystectomy or hepaticojejunostomy, are essential to address anatomical distortions and minimize complications. This review highlights the evolving understanding and management of Mirizzi syndrome, emphasizing the importance of individualized treatment plans to ensure optimal patient outcomes.