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-IRIZZISYNDROME#SENDESTYPE)6 THEORGANWASLEFTINSITUDUE
TO THE ABSENCE OF DISSECTION PLANES BETWEEN THE GALLBLADDER THE
COMMON HEPATIC DUCT AND THE DUODENUM AND TO AVOID IATROGENIC
LESIONOFTHEBILIARYDUCTS
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ANY SYMPTOMS ATTRIBUTABLE TO THE BILIARY TRACT4HIS COURSE REmECTS
AN APPROPRIATE POSTOPERATIVE PERMEABILITY OF THE BILIARY TRACT /N
THEOTHERHAND THECHRONICOBSTRUCTIONOFTHEBILIARYTRACTCANCAUSE
PERMANENT HEPATIC LESION ESPECIALLY WHEN THERE IS SOME DEGREE OF
CHRONICINFECTION )NSUCHASITUATION DUCTALBILIARYPROLIFERATIONIS
FOLLOWEDBYPORTALlBROSIS(OWEVER PROLONGEDCHOLESTASISCANLEADTO
SECONDARYBILIARYCIRRHOSIS7HENTHECHOLESTASISISALLEVIATEDTHERECAN
BEREGRESSION THATISUSUALLYSLOW OFTHEHEPATICHISTOLOGICALFEATURES
ESPECIALLYEVENTUALlBROSISOFTHEPORTALZONESANDDISAPPEARANCEOF
THEINlLTRATIONOFBILIARYPIGMENTS 
4HEROLEOFMINIMALLYINVASIVESURGERYINTHETREATMENTOF-IRIZZI
SYNDROMEREMAINSCONTROVERSIAL3OMEAUTHORS   CONSIDERSUCHA
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SURGERY AS THE ADHERENCES AND INmAMMATORY TISSUE IN THE AREA OF
#ALOTS TRIANGLE OFFER DIFlCULTY IN DISSECTION /THER AUTHORS  
HAVE REPORTED THAT A LAPAROSCOPIC APPROACH ESPECIALLY FOR #SENDES
TYPE ) LESIONS IS FEASIBLE ALBEIT TECHNICALLY DEMANDING (OWEVER
CONVENTIONAL LAPAROTOMY IS USUALLY NECESSARY FOR THE CORRECTION OF
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WITH INITIAL ACCESS BY LAPAROSCOPY WERE CONVERTED TO CONVENTIONAL
SURGERYDUETOTECHNICALDIFlCULTIES
)N PATIENTS WITH -IRIZZI SYNDROME AND A HIGH OPERATIVE RISK
SATISFACTORYRESULTSCANBEOBTAINEDEITHERTHROUGHBILIARYDRAINAGE
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ORNASOBILIARYCATHETERASSOCIATEDWITHELECTROHYDRAULICLITHOTRIPSYBY
CHOLANGIOSCOPY 4HESEPROCEDURESUSUALLYRELIEFTHECHOLANGITISAND
THELOCALINmAMMATORYPROCESS PREPARETHEPATIENTFORSUBSEQUENT
SURGICAL INTERVENTION AND SERVE AS A GUIDE TO AVOID LESION OF THE
BILIARYDUCTS 
7ITHREGARDTOPERFECTINGDIAGNOSTICMETHODSFORBILIARYDISEASE
-IRIZZISYNDROMECONTINUESTOBEACHALLENGEFORTHESURGEON4HE
CONDITIONMAYNOTBERECOGNIZEDBYROUTINEPREOPERATIVEIMAGE
EXAMSANDTHEPROBLEMONLYBECOMEEVIDENTATTHEMOMENTOFTHE
OPERATIONINTHEFORMOFFIRMADHERENCESAROUND#ALOTSTRIANGLE
4HEMAJORFACTORFORTHESUCCESSFULTREATMENTOF-IRIZZISYNDROME
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OFEACHCASE
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INTHISMANUSCRIPT

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