Treatment of Mirizzi Syndrome Type II: Cholecystobiliary Fistula Involving Less Than One-Third of the CBD Circumference
Mirizzi syndrome type II represents a specific anatomical subset in which a gallstone-related fistula has eroded into the common bile duct, involving less than one-third of its circumference. Surgical management in this setting requires a tailored approach that accounts for both the fistula and bile duct integrity.
Clinical scenario: Mirizzi syndrome type II — a cholecystobiliary fistula in which the fistulous communication involves less than one-third of the circumference of the common bile duct. This subtype accounts for approximately 41% of Mirizzi syndrome cases and defines the scope and method of bile duct repair required.
Surgical approach
Management involves a specific sequence beginning with subtotal cholecystectomy, after which the cholecysto-choledochal fistula is addressed using a reconstructive technique that utilises residual gallbladder tissue. The complete surgical algorithm — including repair method selection and biliary drainage considerations — is detailed in the full protocol.
References
DOI: 10.5772/intechopen.1010159
- Mirizzi type II (41% of cases): A fistula involving less than one-third of the circumference of the common bile duct.
- Choledochoplasty is a surgical method employed after subtotal cholecystectomy, where the remaining portion of the gallbladder or cystic duct is used to repair a cholecysto-choledochal fistula.
- The repair can be done by primary closure or by utilizing the cuff of the gallbladder for reconstruction, with or without inserting a T-tube into the common bile duct (CBD).
- This technique is generally applied for type II Mirizzi syndrome and selected cases of type III.
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