BACKGROUND: Mirizzi syndrome is one possible complication of the gallstones. The incidence in patients treated with cholecystectomy is 0.7-1.1%. MATERIALS AND METHODS: We have analyzed on 4123 colecistectomie conduct in Unit of General Surgery and Organ Transplantation of the University of Parma from January 1992 to October 2006, 46 cases of syndrome of Mirizzi (1.1%) with age comprised between 29-82 years (medium 67.8 years) were 28 women (60.9%) and 18 men (39.1%). We have considered the symptomatology, the diagnostic and therapeutic way, the comorbility. RESULTS: In 19 cases (41.3%) there were the signs of acute cholecystitis; in 28 cases (60.9%) the clinical picture was characterized from repeated biliary pain. The jaundice was present in 29 cases (63%) with hyperpyrexia (>38°) in 27 cases (58.7%). In 14 cases (30.4%) was a Mirizzi type I, in 32 cases (69.6%) a Mirizzi of type II. CONCLUSIONS: The Mirizzi syndrome is a diagnosis frequently conduct intraoperatively. The surgical therapy is characterized by the acknowledgment of the biliary structures, the complete removal of the stones, the surgical therapy of the leaks.