2018 SCIENCELINE  
Journal of Life Science and Biomedicine  
J Life Sci Biomed, 8(3): 45-53, 2018  
ISSN 2251-9939  
Diagnosis and Surgical Treatment of Patients with  
Mirizzi Syndrome  
Feruz Gafurovich NAZIROV , Mirshavkat Mirolimovich AKBAROV, Мaksud Shermatovich NISHANOV  
Republican Specialized Center of Surgery named after acad.V.Vakhidov. Tashkent. Uzbekistan.  
Corresponding's Email: khakimov.yunus@mail.ru  
ABSTRACT  
Original Article  
PII: S225199391800008-8  
Introduction. Among patients undergoing cholecystectomy, the Mirizzi syndrome (MS) occurs  
from 0,06% to 5,7%, and it is a difficult problem in all stages of diagnosis and surgical  
treatment. To make a correct diagnosis in the all modern methods, surgical intervention may  
Rec. 14 Dec. 2017  
Acc. 15 Apr. 2018  
Pub. 15 May. 2018  
be done in less than in 12-32% cases. Materials and methods. From 1994 to 2016, 122 patients  
with MS (20 to 84 years old, on average 50,9±0,5 years old) were operated. Patients were  
separated by the Csendes classification of MS. Taking into account the development of  
diagnosis system, the choice of tactics and mode of operative treatment, all patients were  
divided into two groups. Control group including 69 patients were operated from 1994 to 2008  
and the main group contained 53 patients operated from 2009 to 2016. On a number of clinical  
and laboratory methods of investigation it was applied modern instrumental investigation  
methods such as: x-ray examination of gastro-intestinal tract, ultrasound investigation (USI),  
multi spiral computer tomography (MSCT), endoscopic examination of stomach and  
duodenum, endoscopic retrograde pancreatocholangiography (ERPCHG), percutaneously-  
transhepatic cholangiography. Results. The diagnostic value of USI before operation was in the  
following: suspicion of I type of MS was noted in 24,3% of patients, in 37,6% of patients it was  
suspected the existent of II-IY types. On USI before operation in 5,4 % of patients it was verified  
I type and in 18,8 % of patients II-IY type of MS. The use of MRI and MSCT in MS verification  
may increase the efficacy of diagnosis particularly in 2 times in the comparison with USI. But,  
for patients with MS 1 type, this indication remains relatively low and composes only 33,3%.  
This method of diagnosis is more effective in patients with MS 2-4 type because of exact  
diagnosis in 75,0% cases. The most detailed verification was noted on ERPCHG in MS 1 type  
(83,3%). In SM 2-4 type the efficacy of ERPCHG was 81,4%. Uncomplicated post-operative period  
was noted in 83,0% of patients of main group, while in patients of control group this indication  
was only 56,5%. Such difference was noted both in indications of lethality (1,9% in main group  
against 7,2% in control) and in specific complications (15,1% in main group against 39,1% in  
control). Conclusion. It is concluded that the significant increasing of topical diagnosis level of  
MS 1 type in main group (till 42,9%), and for patients with MS 2-4 type this indication in main  
group increased till 19,2% in the comparison with control group. At the same time, stepwise use  
of all complex of diagnostic monitoring may increase the efficacy of correct diagnosis till 97-  
99% in patients with MS 2-4 type. In pre-established MS 1-2 type it is more effectively the using  
of laparoscopic interventions, and in cases of MS 3-4 type a priority remains for the choice of  
open operations (CHEC+draining of choledocha by Ker).  
Keywords  
Mirizzi Syndrome,  
Mechanical Jaundice,  
Ultra Sound  
Investigation, Multi  
Spiral Tomography.  
INTRODUCTION  
Mirizzi syndrome (МS) is quite rare pathology, the incidence of it among elder population composes of less 1% in  
a year in developed Western countries and 4,7-5,7% in developing countries [1-5]. A number of observations of  
Mirizzi syndrome is increasing at recent years, which associated with increase of morbidity of bile stone  
diseases, decreasing of surgical activity in acute cholecystitis attack and examination of patients, surgery  
progress of bile ducts, best knowledge of surgeons of this complication. At present, by the data of most authors,  
To cite this paper: Nazirov F.G., Akbarov M.M., Nishanov М.Sh. (2018). Diagnosis and Surgical Treatment of Patients with Mirizzi Syndrome. J. Life Sci. Biomed.  
8(3): 45-53; www.jlsb.science-line.com  
the rate of morbidity of Mirizzi syndrome composes of 0,3-5%, and among patients with bile stone disease – 0,1-  
2,7% [3, 4, 6-13].  
The standard in pre-operative diagnosis of Mirizzi syndrome for several decades is the methods of direct  
contrast of bile ducts. Among them the most often using method is endoscopic retrograde  
cholangiopancreatography, which is thought by some authors more informative in diagnosis of syndrome [6,  
14]. Other authors indicate on high sensitivity and safety of pre-operative diagnosis methods such as spiral  
computer tomography, magnetic resonance cholangiopancreatography [14, 15, 16].  
The issues in regard to surgical correction of Mirizzi syndrome remain undecided. In modern surgery  
there are different ways of treatment of this syndrome. They may be divided in endoscopic and surgical.  
Laparoscopic treatment methods are used successfully in I type of syndrome. At the same time, some authors  
consider that the syndrome of Mirizzi is absolute or relative contraindication for laparoscopic operation,  
especially not diagnosed in pre-operative period [16]. Antoniou et al. [6] in the literature review on using of  
laparoscopic technique in syndrome of Mirizzi points to 40% of access conversion, 20% of complications and 6%  
of repeated operations. But there are a number of publications, which authors point to possibility of using of  
laparoscopic technique under certain conditions [17-21]. Kwon and Inui [15] point to possibility of applying of  
laparoscopic method by experienced surgeon only in first type of syndrome.  
Today the most of surgeons choose the performing of cholecystectomy from the bottom, completed with  
draining of choledocha [4, 22-24]. Difficulties in diagnosis, as well as necessity of modern their methods  
involving, enough wide range of using and recommending methods of surgical treatment, a few observations,  
and absence of single recommendations determine the actuality of studying of this problem.  
MATERIAL AND METHODS  
The work was based on retrospective analysis of investigations of 122 patients with MS, treated in surgery  
departments of liver and bile ducts, and portal hypertension and pancreatoduodenal zone in republican  
specialized center of surgery named after V. Vakhidov from 1994 to 2016. Taking into account the development  
of diagnosis system, the choice of tactics and way of operative treatment all patients were divided into two  
groups. In control group it was included 69 patients, who were operated from 1994 to 2008. The main group  
contained 53 patients operated from 2009 to 2016.  
The age of patients varied from 20 to 84 years old (on average 50,9±0,5 years old). The females were more  
– 88 patients against 34 male patients (the ratio 2,6:1). The main complains, having in admission, were pains on  
right upper quadrant of abdomen, periodical icterus of skin covering and sclera, clinical manifestations of  
cholangitis in the form of chill, increasing of body temperature. The pains on right upper quadrant of abdomen  
were noted by 122 (100%) patients, clinic of mechanical jaundice was observed in 90 (73,7%) of patients. The  
incidence of cholangitis was noted by 23 (18,8%) patients. In 7 (5,7%) patients there was incidence of hepatic  
insufficiency.  
Terms from the beginning of disease to the moment of admission into clinic were different in our patients  
and varied from 1 month to 33 years, and in some cases the duration of disease was unknown, including patients  
with asymptomatic cholecystolithiasis. Duration of bile stone history was as follows: till 1 years in 45 (36,9%)  
patients, from 1 to 3 years in 14 (11,5%) patients, more than 3 years in 56 (45,9%) patients, and in 7 (5,7%) patients  
the duration of disease was not identified. In 30 (24,5%) patients the attack of pains was the first time and in 92  
(75,5%) patients there were two or more attacks in history. Symptoms of mechanical jaundice in history were  
observed in 21 (17,2%) patients.  
Along with the clinical and laboratory methods of investigation it was applied modern instrumental  
investigation methods such as: x-ray examination of gastro-intestinal tract, ultrasound investigation (USI),  
multi spiral computer tomography (MSCT), endoscopic examination of stomach and duodenum, endoscopic  
retrograde pancreatocholangiography (ERPCHG), percutaneously-transhepatic cholangiography. Including of  
one or another method into investigation was determined with the help of appropriate indications. The tactics  
of surgical treatment of patients with MS was made depending on the type of syndrome. Patients were  
distributed with the help of Csendes A classification for MS (Table 1).  
Ethical approval  
The review board and ethics committee of RSCS named after acad. V.Vakhidov approved the study  
protocol and informed consents were taken from all the participants.  
To cite this paper: Nazirov F.G., Akbarov M.M., Nishanov М.Sh. (2018). Diagnosis and Surgical Treatment of Patients with Mirizzi Syndrome. J. Life Sci. Biomed.  
8(3): 45-53; www.jlsb.science-line.com  
Table 1. Distribution of patients by the type of Mirizzi syndrome (MS)  
Main group Control group  
All  
Type of SM  
abs.  
14  
13  
23  
3
%
abs.  
%
abs.  
37  
37  
42  
6
%
Type I  
Type II  
Type III  
Type IV  
Total  
26,4%  
24,5%  
43,4%  
5,7%  
23  
24  
19  
3
33,3%  
34,8%  
27,5%  
4,3%  
30,3%  
30,3%  
34,4%  
4,9%  
53  
100,0%  
69  
100,0%  
122  
100,0%  
abs. = absence of single recommendations  
RESULTS AND DISCUSSION  
In our clinic it was hospitalized 16549 patients with bile stone disease. From this group 14820 (89,5%)  
patients were operated. Other patients were discharged because of different reasons (severity of concomitant  
diseases, necessity of rehabilitation after elimination of the block for bile flow in mechanical jaundice (MJ),  
abandonment of an operation and other). In general, for the whole group of operated patients the developing  
rate of MS composed 0,82% (122 from 14820 patients). For all 122 patients it was made the USI of organs of  
abdomen. From the data of table 2, which shows diagnostic efficacy of USI in verification of this diagnosis, it has  
been mentioned that the most low diagnostic efficacy of USI has been noted in group of patients with SM I type,  
with largest percentage of not established diagnosis.  
Active using of MRI and MSCT in surgery of liver and extrahepatic bile ducts, which attracted specialist  
dealing with the problem of MS, allowed significantly increasing percentage of exact diagnosis. In table 3 it was  
showed the indications of efficacy assessment of MRI and MSCT using in our patients. The using of MRI or  
MSCT in verification of MS may increase the efficacy of diagnosis practically in 2 times in comparison with USI.  
But, for patients with MS type 1 this indication remains relatively low and composes only 33,3%. The highest  
efficiency of this diagnosis method is determined in patients with SM 2-4 type with exact made diagnosis in  
75,0% of cases. Next, it is performing of ERPCHG, which is not only diagnostic stage but also realizes treatment  
function. Indications of efficacy of ERPCHG in diagnosis of MS were presented in table 4. From the table 4, it is  
noted more meaningful verification of ERPCHG in MS 1 type (83,3%). In SM 2-4 type the efficacy of ERPCHG  
composed 81,4%. On the Picture 1 (А, B) and 2 it is demonstrated all parties of ERPCHG of topical diagnosis of  
MS.  
Results in a cumulative distribution of patients by type of performed operative treatment are presented in  
table 5. One should mention, the specter of operative intervention variants have been practically identical in  
both groups that characterize persistent conservatism in choice of operative approach during long-term period,  
except the using of holedohoduodenoanastomoz (CHDA), which at present practically is not applied. At the  
same time, a number of open cholecystectomy (CHEC) with draining of choledocha by Ker, at present, is  
dominant operation in MS and corresponds to modern standards in the choice of operative treatment type.  
In table 6 it is noted the increasing of laparoscopic intervention rate performed in control group (9,4%  
against 3,8%), in the smallest amount of conversion (3,8% against 15,9% respectively). Nevertheless, amount of  
open operative interventions was practically the same in both groups. The distribution of patients depending  
on the performing of stage tactics in MS is presented in table 7, which shows that this indication composed  
37,7% in main group against 10,1% in control group. Such big difference in indications points to significant  
changes in MS treatment tactics of complicated mechanical jaundice (MJ) with mandatory use of one of the  
ways of biliary decompression before main operative stage.  
The most principal moment in benign surgical pathology is assessment of this type of intervention by  
recent results. Assessment of surgical treatment of patients with MS we decided to consider with position: 1)  
analysis of recent results of surgical treatment of MS in comparison groups; 2) comparison analysis of structure  
and the rate of post-operative complications depending on the type of MS; 3) distribution of post-operative  
complications depending on the type of operation; 4) assessment of surgical intervention risk in patients with  
MS.  
As can be seen from diagram 3, which shows general structure of comparison results of surgical treatment  
of MS, it is mentioned significant difference by all indications in comparison groups. Thus, uncomplicated post-  
operative period was noted in 83,0% of patients of main group, while in patients of control group this indication  
composed only 56,5%. Such difference was noted both in indications of lethality (1,9% in main group against 7,2%  
in control) and specific complications (15,1% in main group against 39,1% in control).  
To cite this paper: Nazirov F.G., Akbarov M.M., Nishanov М.Sh. (2018). Diagnosis and Surgical Treatment of Patients with Mirizzi Syndrome. J. Life Sci. Biomed.  
8(3): 45-53; www.jlsb.science-line.com  
 
Next analyzed item was to study the rate of post-operative complications depending on the type of MS  
(Table 8). Thus, the seam failure of choledocha was noted in 1 patients (7,1%) with MS 1type and in 4 (15,4%)  
patients with MS 3-4 type in main group. In control group this complication was noted in 2 patients (8,7%) with  
MS 1 type, in 4 patients (16,7%) with MS 2 type and in 5 patients (22,7%) with MS 3-4 type.  
Table 2. Diagnostic efficacy of USI in verification of MS  
Suspicion on MS  
Accurately verified  
Undiagnosed  
Type of MS  
Number  
abs.  
%
abs.  
2
%
abs.  
%
type I  
37  
85  
9
24,3%  
37,6%  
33,6%  
5,4%  
18,8%  
14,7%  
26  
37  
63  
70,3%  
43,6%  
51,7%  
Type II-IV  
Total  
32  
41  
16  
18  
122  
Table 3. Diagnostic efficacy of MRI and MSCT in verification of MS  
Suspicion on SM  
Accurately verified  
Undiagnosed  
Type of MS  
Number  
abs.  
%
abs.  
3
%
abs.  
3
%
Type I  
9
3
6
9
33,3%  
15,0%  
16,7%  
33,3%  
82,5%  
66,6%  
33,3%  
15,0%  
16,7%  
Type II-IV  
Total  
45  
54  
33  
36  
6
9
Table 4. Diagnostic efficacy of ERCHPG in verification of MS  
Suspicion on MS  
Accurately verified  
Undiagnosed  
Type of MS  
Number  
abs.  
%
abs.  
3
%
abs.  
1
%
Type I  
6
2
33,3%  
14,3%  
15,8%  
50%  
16,7%  
18,6%  
18,4%  
Type II-IV  
Total  
70  
76  
10  
12  
47  
50  
67,1%  
65,8%  
13  
14  
Table 5. A cumulative distribution of patients by type of performed operative treatment  
Control group Main group  
Type of operation  
abs.  
55  
11  
15  
17  
5
%
abs.  
%
Open operation  
79,7%  
15,9%  
21,7%  
24,6%  
7,2%  
4,3%  
2,9%  
2,9%  
2,9%  
1,4%  
0,0%  
15,9%  
4,3%  
7,2%  
5,8%  
1,4%  
42  
4
27  
3
79,2%  
7,9%  
50,9%  
5,7%  
5,7%  
3,8%  
5,7%  
0,0%  
9,4%  
3,8%  
3,8%  
3,8%  
5,7%  
5,7%  
1,9%  
0,0%  
1,9%  
1,9%  
1,9%  
Cholecystectomy  
CHEC+draining by Ker  
CHEC+plastic+ draining by Ker  
CHEC+ Pikovskiy  
3
HepJA  
3
2
3
CHEC, restoring hepatiko choledocha on carcass drainage  
CHEC, dissociation of duodenal fistula, application of HepDA  
Laparoscopic anastomosis  
2
2
0
5
2
2
2
3
2
Laparoscopic operation with draining of choledocha by Pikovskiy  
Laparoscopic operation with draining of choledocha on Т- shaped drainage  
Laparoscopy with conversion  
1
0
11  
3
Cholecystectomy  
CHEC+draining by Ker  
5
3
CHEC+plastic+ draining by Ker  
4
1
CHEC+ Pikovskiy  
1
0
1
HepJA  
0
0,0%  
5,8%  
4,3%  
CHEC, restoring hepatiko choledocha on carcass drainage  
CHEC, dissociation of duodenal fistula, application of HepDA  
4
1
3
1
To cite this paper: Nazirov F.G., Akbarov M.M., Nishanov М.Sh. (2018). Diagnosis and Surgical Treatment of Patients with Mirizzi Syndrome. J. Life Sci. Biomed.  
8(3): 45-53; www.jlsb.science-line.com  
 
А) Gallbladder was arrested. GHD was squeezed from the B) Gallbladder was arrested. GHD was squeezed from the  
outside, along the lateral contour, perhaps by gallbladder outside (MS 2 type), with the aim of decompression of biliary  
(MS 1 type). Suprastenotic ectasia of right, left and general tract it was performed the stenting of general bile duct.  
hepatic ducts.  
Picture 1 А, B. Imaging of MS in its EPHGDS verification  
А) On the level of confluence of cystic duct there is repletion B) Symptom of «sandglass» with defect of the whole  
defect, deforming lateral contour of general hepatic duct. semicircle repletion of GHD (MS 4 type). Slow roundabout  
Intrahepatic ducts and general hepatic duct (GHD) above the contrast of proximal part of choledocha at the expense of  
level of compression are enlarged (MS 3 type)  
vesicular-choleadocic fistula  
Picture 2 А, B. Imagine of MS in its EPHGDS verification  
Table 6. Type of operative treatment of Mirizzi syndrome in comparison groups  
Main group  
Control group  
All  
Type of operation  
abs.  
%
abs.  
%
abs.  
97  
%
Open operation  
42  
9
79,2%  
17,0%  
3,8%  
55  
3
79,7%  
4,3%  
15,9%  
79,5%  
9,8%  
10,7%  
Laparoscopic operation  
Laparoscopy with conversion  
12  
2
11  
13  
Criteria of authenticity by operation type  
χ2=9,030; Df=3; p=0,037  
Open and laparoscopy with conversion  
Total  
44  
53  
83,0%  
66  
69  
95,7%  
110  
122  
90,2%  
100,0%  
100,0%  
100,0%  
To cite this paper: Nazirov F.G., Akbarov M.M., Nishanov М.Sh. (2018). Diagnosis and Surgical Treatment of Patients with Mirizzi Syndrome. J. Life Sci. Biomed.  
8(3): 45-53; www.jlsb.science-line.com  
 
Table 7. The distribution of patients by the type of two-stage intervention  
Main group  
Control group  
First stage of treatment  
abs.  
8
%
abs.  
2
%
PTCHG  
15,1%  
13,2%  
9,4%  
2,9%  
4,3%  
2,9%  
10,1%  
Nosobiliary draining  
Lost drainage  
Total  
7
3
5
2
20  
37,7%  
7
Criteria of authenticity  
χ2=8,527; Df=3; p=0,047  
100%  
80%  
60%  
40%  
20%  
0%  
Criteria χ2=26,323; Df=5; p<0,001  
83.0%  
56.5%  
43.5%  
39.1%  
26.1%  
17.0%  
15.1%  
7.2%  
1.9%  
1.9%  
Main group  
Control group  
without complications  
patients with complications  
lethality  
spesific complications  
non-spesific complications  
Diagram 3. Results of surgical treatment of MS  
Table 8. The rate of post-operative complications depending on the type of MS  
Suppuration of  
wound or sub  
diaphragmatic  
abscess  
The seam  
failure of  
choledocha insufficiency  
Progression  
of liver  
Non-specific  
complications  
of organs  
Residual  
stone  
Bleeding  
The group and  
type of operation  
abs.  
%
abs.  
%
abs.  
%
abs.  
%
abs.  
%
abs.  
%
Control group  
Type I of MS  
2
2
8,7%  
1
1
4,3%  
6,7%  
0
0
0,0%  
0,0%  
1
4,3%  
0,0%  
6
6
26,1%  
0
0
0,0%  
0,0%  
-Open operation  
13,3%  
0
40,0%  
-Laparoscopic  
operation  
0
0,0%  
0
0,0%  
0
0,0%  
1
50,0%  
0
0,0%  
0
0,0%  
Type II of MS  
4
3
16,7%  
16,7%  
1
1
4,2%  
5,6%  
0
0
0,0%  
0,0%  
3
2
12,5%  
11,1%  
4
3
16,7%  
16,7%  
2
2
8,3%  
11,1%  
-Open operation  
-Laparoscopy with  
conversion  
1
16,7%  
0
0,0%  
0
0,0%  
1
16,7%  
1
16,7%  
0
0,0%  
Type III and IV of MS  
-Open operation  
5
5
22,7%  
22,7%  
4
4
18,2%  
18,2%  
2
2
9,1%  
9,1%  
1
1
4,5%  
4,5%  
8
8
36,4%  
36,4%  
1
1
4,5%  
4,5%  
Main group  
Type I of MS  
-Open operation  
1
1
7,1%  
12,5%  
0,0%  
15,4%  
15,4%  
0
0
0
0
0
0,0%  
0,0%  
0,0%  
0,0%  
0,0%  
0
0
0
1
0,0%  
0,0%  
0,0%  
3,8%  
3,8%  
0
0
0
1
0,0%  
0,0%  
0,0%  
3,8%  
3,8%  
0
0
0
1
0,0%  
0,0%  
0,0%  
3,8%  
3,8%  
0
0
0
1
0,0%  
0,0%  
0,0%  
3,8%  
3,8%  
Type II of MS  
0
4
4
Type III and IV of MS  
-Open operation  
1
1
1
1
To cite this paper: Nazirov F.G., Akbarov M.M., Nishanov М.Sh. (2018). Diagnosis and Surgical Treatment of Patients with Mirizzi Syndrome. J. Life Sci. Biomed.  
8(3): 45-53; www.jlsb.science-line.com  
 
The low diagnostic efficiency of USI in verification of MS was noted in group of patients with MS I type,  
with the highest percentage of not established diagnosis (57,1% in main and 78,3% in control groups).  
Nevertheless, in main group almost in 2 times it was increased the percentage of typing diagnosis. The highest  
percentage of correct made diagnosis was noted in patients with MS II-IV type (23,1% against 15,2%  
respectively). In main group of patients with MS II-IV type it was decreased significantly the percentage of  
unverified diagnosis (30,8% against 54,3% respectively).  
Verification of diagnosis on the base of totality of main USS signs of MS allows to increase diagnostic  
efficacy of this method till 18,9% in all types, and for 2-4 type particularly till 23,1%. The use of MRI and MSCT in  
verification of MS allows increasing the efficiency of diagnosis in 2 times in comparison with USS. But, for  
patients with MS 1 type this indication remains relatively low and composes only 33,3%. The highest efficiency  
of this diagnosis method is revealed in patients with MS 2-4 type with exact made diagnosis in 75,0% cases. The  
efficacy of ERPCHG in MS 1 type composes 66,7%, and in MS 2-4 type it increases till 75,8%, which associated  
with increasing of efficiency of beam diagnostic methods, not with the improvement of technical components of  
this method. It was noted significant increasing of topical diagnosis level of MS 1 type in main group (till 42,9%),  
and for patients with MS 2-4 type this indication in main group increased till 19,2% in comparison with control  
group. At the same time, stage using of all complex of diagnostic monitoring may increase the efficacy of  
making of correct diagnosis till 97-99% in patients with MS 2-4 type.  
The use of stage surgical tactics, when on the first stage it was performed one of the variants of small-  
invasive biliary tract decompression, was characterized with the increasing of amount of planned surgical  
interventions (90,6% against 69,6%), the highest percentage of applying of laparoscopic technologies (16,98%  
against 4,35%) in minimal quantity of conversion (3,8% against 15,94%) and as a result: uncomplicated post-  
operative period was noted in 83,0% of patients of main group, while in patients of control group this indication  
composed only 56,5%. Such difference was noted both in indications of lethality (1,9% in main group against 7,2%  
in control) and specific complications (15,1% in main group against 39,1% in control).  
Renouncement from emergency surgery in favor of actively expectant tactics in MS allows to increase the  
rate of good results after operation till 26,5%, to reduce the quantity of specific and non-specific post-operative  
complications till 24,0% and 24,2% respectively, and lethality till 5,3%.  
CONCLUSION  
The main tasks of therapeutic and diagnostic tactics in MS in the condition of given qualified and  
specialized medical care are follows:  
Collection of anamnestic data and determination of risk factors of MS developing;  
Use of high technologic beam diagnosis with establishment the character of complication;  
Assessment of efficiency of combined use of all diagnostic complex in MS verification;  
Assessment of severity stage of clinical course of syndrome, determination of complicated course of  
underlying disease and concomitant pathology;  
In patients with MJ, the first stage of therapeutic tactics is one of the ways of small-invasive  
endoscopic or endovascular decompression of biliary tract;  
In preliminarily established MS 1-2 type the preference should be given to laparoscopic intervention,  
and in the case of revealing of MS 3-4 type the priority remains for the choice of open operation  
(CHEC+draining of choledocha by Ker).  
DECLARATIONS  
Acknowledgements  
This work was supported by Republican Specialized Center of Surgery named after acad.V.Vakhidov.  
Tashkent.  
Authors’ Contributions  
All authors contributed equally to this work.  
Competing interests  
The authors declare that they have no comp eting interests.  
To cite this paper: Nazirov F.G., Akbarov M.M., Nishanov М.Sh. (2018). Diagnosis and Surgical Treatment of Patients with Mirizzi Syndrome. J. Life Sci. Biomed.  
8(3): 45-53; www.jlsb.science-line.com  
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