Juan José Granados-Romero

Updates in Mirizzi syndrome

Mirizzi syndrome, known as extrinsic bile compression syndrome, is a rare complication of cholecystitis and chronic cholelithiasis, secondary to the obliteration of the infundibulum of the gallbladder or cystic duct caused by the impact of one or more calculations in these anatomical structures, which leads to compression of the adjacent bile duct, resulting in partial or complete obstruction of the common hepatic duct, triggering liver dysfunction. Our aim is to identify and describe the current epidemiology, diagnostic methods, and treatment of Mirizzi syndrome. A literature search was performed using different databases, including Medline, Cochrane, Embase, Medscape, PubMed, using keywords: Mirizzi syndrome, epidemiology, markers, pathophysiology, clinical presentation, diagnosis, and treatment. Selected original articles, review articles or case reports from 1997 to 2015 were collected, written in English or Spanish. The endoscopic retrograde cholangiopancreatography (ERCP) is the most accurate diagnostic method. The traditional treatment has been surgery and involves an incision at the bottom of the gallbladder and calculus removal. If fistulas are observed, it is performed a partial cholecystectomy; otherwise, a cholecystocholedochoduodenostomy is an alternative. Endoscopic treatment includes biliary drainage and stone extraction. Many surgeons claim that laparoscopic cholecystectomy is contraindicated in Mirizzi syndrome because of the presence of inflammatory tissue and adhesions in the Calots triangle. If dissection is attempt, it can cause unnecessary injury to the bile duct. However, other surgeons consider the laparoscopic approach is feasible, although technically challenging. Currently, laparoscopic cholecystectomy for this condition is considered controversial and technically challenging; however, it has shown that with the right skills and equipment, it is a safe and feasible way to treat some cases of Mirizzi syndrome type I and II.

Affordable laparoscopic simulator to acquire basic skills in undergraduate surgery students

The laparoscopic surgery has proved to be the main approach for a number of pathologies that require surgical intervention. This due to its lower incidence of complications, to a faster recovery time compared to traditional open surgery and reduction of surgery time1. This has led to the need in training and acquisition of skills in minimally invasive surgery in early stages of the medical career of students inclined toward a surgical specialty. The complications during this learning process have resulted in ethical considerations, imposed by the medical profession, specifically in the use of humans and animals in the surgical training.2 This has led to the development of simulator devices to develop skills and training of surgeons. These aspects are not confined to the postgraduate students, study plans at the undergraduate level generate an imminent need to ABSTRACT