Abstract

Dear Editor-in-Chief,

Early cholecystectomy is recommended in the management of acute cholecystitis. Laparoscopic cholecystectomy is the gold standard method. However, in emergency surgery, bile duct injury is one of the most common complications. Although numerous surgical techniques have been described for safe cholecystectomy, the most important issue is to identify cases that may lead to complications during the intraoperative period and apply the appropriate bail-out strategy (1).
Mirizzi syndrome is one of the most common anatomical variation leading to complications, especially biliary duct injury (2) (Figure 1).
For this purpose, we aim to present an easy concept for identifying Mirizzi syndrome intraoperatively using the “tree trunk shaking” metaphor. According to this proposed metaphor, the gallbladder is held at the beginning of the operation using a laparoscopic grasper from the fundus. In a case of an anomaly, when the grasper holding the fundus is pulled to the right or left, it can be seen that the gallbladder and attached biliary duct, most likely the main biliary duct, move as a single block, like as if a “thick tree trunk were shaking,” up to the duodenum. In this situation, we assume that there is a high probability that a type of Mirizzi syndrome is present (Figure 2).

Key words: mirizzi syndrome, laparoscopic cholecystectomy, biliary duct injury, subtotal cholecystectomy