Methods Patients who received elective or emergency cholecystectomies in our center during 23 years were retrospectively evaluated. The data reviewed included demography

clinical presentations

diagnostic Methods

surgical procedures

postoperative complications

and follow-up.Results There were 27 patients diagnosed with MS among 8697 cholecystectomies performed during that period. The preoperative diagnostic modalities included ultrasonography

computed tomography

magnetic resonance cholangiopancreatography

and endoscopic retrograde cholangiopancreatography. The incidence of MS Type I (12/27

44.4%) had the dominance in the four types

the incidence of MS Type II and III were 33.3% (9/27) and 22.2% (6/27)

and there were no MS Type IV patients. Laparoscopic cholecystectomy was performed in 15 (55.6%) patients

but only 3 (11.1%) patients with MS Type I had a successful surgery

and the other 12 were converted to open cholecystectomy. The remaining 12 patients directly underwent open cholecystectomy. The surgical procedures except laparoscopic cholecystectomy included simply open cholecystectomy (including laparoscopic cholecystectomy converted to open cholecystectomy) (6/27

22.2%)

open cholecystectomy

T-tube placement with choledochotomy (9/27

33.3%)

open cholecystectomy

closure of the fistula with gallbladder cuff

T-tube placement (3/27

11.1%)

and open cholecystectomy with excision of the external bile ducts

and Roux-en-Y hepatico-jejunostomy (6/27

22.2%). Of them

88.9% (24/27) patients recovered uneventfully and were discharged in good condition without any operation related mortality.Conclusions Endoscopic retrograde cholangiopancreatography is a good method with diagnostic and therapeutic purposes. Total or partial cholecystectomy is generally adequate for MS Type I. For MS Type II-IV

paritial cholecystectomy

choledochoplasty

or if impossible

Roux-en-Y hepatico-jejunostomy may be performed. Laparoscopic cholecystectomy may be successful in selected preoperatively diagnosed MS Type I patients

and open cholecystectomy is the standard therapeutic method.