Mirizzi syndrome type Vb with cholecystogastric fistula causing gastric outlet obstruction: A case report

Table 1 Dynamic changes in liver function tests

Parameter1	Preoperative	POD 1	POD 3	POD 10 (discharge)
ALT (U/L)	131.0	80.0	53.2	34.4
AST (U/L)	97.2	37.9	22.1	18.3
Total bilirubin (μmol/L)	6.2	3.0	5.7	3.0
Direct bilirubin (μmol/L)	4.42	2.70	1.5	0.8
Albumin (g/L)	34.6	33.5	35.0	37.1
Total protein (g/L)	53.2	52.2	54.8	64.5
C-reactive protein (mg/L)	46.9	55.0	30.0	10.0

¹Values for intermediate postoperative time points are approximate and reflect the overall laboratory trend observed during hospitalization.

POD: Postoperative day; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase.

Table 2 Timeline of clinical events

Time	Event
6 months pre-admission	Onset of progressive vomiting, early satiety, and unintentional weight loss
Admission	Hospital admission with clinical confirmation of gastric outlet obstruction
Diagnostic workup	Magnetic resonance imaging and contrast upper gastrointestinal study
Surgery	Distal gastrectomy with Billroth II reconstruction and cholecystectomy
Postoperative day 10	Discharge in satisfactory condition
Follow-up	Complete resolution of symptoms and restoration of oral intake

Table 3 Comparison of open vs laparoscopic surgery in Mirizzi syndrome (literature-based)

Parameter	Open surgery	Laparoscopic surgery
Typical indication	Advanced Mirizzi syndrome (type III-V/Vb), cholecystoenteric fistula	Selected early-stage cases
Preoperative diagnosis	Often uncertain; diagnosis frequently established intraoperatively	Similar limitations
Technical feasibility	High due to direct anatomical control	Limited in advanced disease
Conversion rate	Not applicable	High in advanced stages
Perioperative mortality	Low	Low
Procedure-related morbidity	Acceptable; mainly related to disease severity	Higher in advanced disease
Risk of bile duct injury	Lower with controlled dissection	Increased in distorted anatomy
Recurrence of biliary symptoms	Low after definitive surgery	Variable
Long-term outcome	Generally favorable	Favorable only in selected cases