Preoperative Recognition and Management of Mirizzi Syndrome—A Systematic Review of Individual Cases

Background/Objectives: Mirizzi syndrome (MS) alters biliary anatomy, complicating diagnosis and treatment. We characterized diagnostic pathways in reported cases and compared Csendes type I with types II–V. Methods: PubMed and Scopus were searched through 1 July 2026, supplemented by citation searching. Reports of five or fewer patients were eligible. Patient-level diagnostic, treatment, and outcome data were summarized; groups were compared using Fisher’s exact and Mann–Whitney U tests. Results: We included 133 publications reporting 141 patients. MS was diagnosed preoperatively in 115/138 patients (83.3%). Recognition was more frequent in type I than types II–V (92.5% vs. 76.7%; p = 0.037) and among patients with conventional imaging (94.0% vs. 76.0%; p = 0.014). ERCP use and the number of modalities did not differ by diagnostic status. Compared with type I, types II–V more frequently required bile-duct exploration (37.1% vs. 17.0%), underwent open surgery (43.5% vs. 24.5%), and developed bile leak (24.1% vs. 8.5%) or treatment-related bile-duct injury (24.1% vs. 4.3%). Conclusions: Preoperative recognition was common but less frequent in fistulizing forms. Anatomical classification and conventional imaging may assist operative planning, whereas accumulating modalities showed no diagnostic advantage.