Treatment of Mirizzi Syndrome Type III: Cholecystobiliary Fistula Involving One-Third to Two-Thirds of the Common Bile Duct

This protocol addresses Mirizzi syndrome presenting as a type III lesion, in which a cholecystobiliary fistula involves between one-third and two-thirds of the circumference of the common bile duct. This anatomical extent places the repair in a technically demanding category — the fistula is too large to manage as a simple type II but does not yet involve more than two-thirds of the duct.

Mirizzi type III accounts for a substantial subset of cholecystobiliary fistula presentations. The fistula involves between one-third and two-thirds of the common bile duct's circumference, demanding a surgical approach that protects the bile duct while achieving complete clearance of the diseased tissue.

Management involves cholecystectomy combined with surgical exploration of the common bile duct, which may be performed by either open or laparoscopic technique. The approach includes access to the bile duct through a dedicated incision, with protective drainage of the sutured area.