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Introduction:Mirizzi syndrome (MS) is a rare complication of cholelithiasis. Despite the success of laparo-scopic cholecystectomy as a minimally invasive approach to gallstone disease, MS remains a challenge, also foropen and robotic approaches, due to the subverted anatomy of the hepatocystic triangle. Moreover, whenemergency surgery is needed, the optimal preoperative diagnostic assessment could not be always achievable.We aim to analyze our experience of MS treated in emergency and to assess the feasibility of a diagnostic andtherapeutic decisional algorithm.Methods:From March 2006 to February 2016, all patients with a preoperative diagnosis, or an intraoperativeevidence of MS, were retrospectively analyzed at our Academic Hospital, including patients operated on inemergency or in deferred urgency. Eighteen patients were included in the study using exclusion criteria andwere treated in elective surgery.Results:The patients were distributed according to modified Csendes’ classification: type I in 15 cases, type IIin 2, type III in 0, type IV in 1, and type V in 0. In the type I group, diagnosis was intraoperatively performed.Laparoscopic approach was performed with cholecystectomy or subtotal cholecystectomy, when the hepato-cystic triangle dissection was hazardous. Patients with preoperative diagnosis of acute abdomen and MS type IVwere directly managed by open approach.Conclusions:Diagnosis of MS and the therapeutic management of MS are still a challenge, mostly in anemergency setting. Waiting for standardized guidelines, we propose a decisional algorithm in emergency,especially in nonspecialized centeres of hepatobiliary surgery

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