Combination of electrohydraulic lithotripsy and laparoscopy for gallbladder access in type III Mirizzi syndrome. Issue 2 (13th December 2018)

• Record Type: Journal Article
• Authors: Nitta, Toshikatsu; Chino, Yoshihide; Kataoka, Jun; Ohta, Masahito; Tominaga, Tomo; Fujii, Kensuke; Ishibashi, Takashi
• Is Part Of: Asian journal of endoscopic surgery. Volume 12:Issue 2(2019)
• Page Start: 227
• Page End: 231
• Publication Date: 2018-12-13
• Subjects: Electrohydraulic lithotripsy -- Mirizzi syndrome -- subtotal cholecystectomy; Endoscopic surgery -- Periodicals; Endoscopic surgery -- Asia -- Periodicals; 617.05705
• DOI: 10.1111/ases.12602
• Languages: English
• ISSNs: 1758-5902

Abstract

Abstract: Introduction: A 50‐year‐old Japanese man presented with obstructive jaundice. We performed endoscopic retrograde biliary drainage before biliary decompression. CT showed a thickened gallbladder wall with low‐density areas and a 35‐mm gallstone; the stone was impacted in the gallbladder neck and cystic duct. The patient was therefore diagnosed with Mirizzi syndrome (type II or III) and scheduled for laparoscopic treatment. We performed subtotal cholecystectomy and intraoperative choledochoscopy because we recognized a fistula between the gallbladder and common bile duct preoperatively. Materials and Surgical Technique: We opened the ductus choledochus, and a choledochoscope was introduced under laparoscopic guidance. An electrohydraulic lithotripsy probe with irrigation was passed through the choledochoscope to extract the gallstone. Discussion: This fragmentation technique is effective for impacted large stones observed in Mirizzi syndrome. Therefore, electrohydraulic lithotripsy with laparoscopy is effective in cases of difficult gallbladder access such as that that occurs in type II or III Mirizzi syndrome.