Dr. Shahram Nazari


The 40th Annual congress of Iranian Association of Surgeons, Tehran, Iran

The 40th Annual congress of Iranian Association of Surgeons, Tehran, Iran
May 09-13, 2016 Razi center for conference Halls, Tehran, Iran.

Abstracts

Laparoscopic Common Bile Duct Exploration

Shahram.Nazari, MD1
(1)Department of Surgery, Erfan Hospital, Tehran, Iran
Abstract
OBJECTIVES: Common bile duct (CBD) stones are found in approximately 16% of patients undergoing laparoscopic cholecystectomy (LC). Clinical models are inaccurate in predicting CBD stones. Prior to the development of LC, the management of these patients included CBD exploration at the time of cholecystectomy. In the era of LC, because of an obvious lack of expertise in laparoscopic surgery, if the diagnosis of choledocholithiasis was established during intraoperative cholangiography (IOC), the surgeon was confronted with the choice between conversion to open surgery, or postoperative ERCP (two-stage treatment). With increasing experience of laparoscopic surgeons, it seemed logical to develop a mini-invasive one-stage Laparoscopic common bile duct exploration (LCBDE). METHODS: This study evaluates our results of LCBDE in a series of 960 patients treated over 106 months. The purpose of this study is to evaluate the feasibility and safety of LCBDE during LC. The inclusion criterion was the presence of ultrasound proven gallstones. Patients were excluded from the study if there was evidence of carcinoma of the gallbladder. RESULTS: CBD stones were demonstrated in 108 patients by routine IOC. For 17 patients, post-operative ERCP was performed. LCBDE was done in 91 patients; all LCBDEs were completed laparoscopically. In 41 patients, CBD closed on a C-Tube and in 29 patients LCBDE completed with T-tube insertion. In 38 cases no CBD drainage was performed. In 98 cases flexible choledochoscopy was done. Choledochoduodenostomy was performed in 45 cases. The mean operative time was 90-130 minutes (mean 85), which is significantly greater than conventional LC (range 20-40 minutes, mean 30). LCBDE was performed without immediate or late major complications. CONCLUSION: There are no debates in the detection and the management of CBD stones in the era of LC. LCBDE is a cost-effective, efficient, and minimally invasive method of treating choledocholithiasis. RECOMMENDATION: We believe that for surgeons familiar with open common bile duct exploration and laparoscopic cholecystectomy, the next logical step is laparoscopic exploration of the common bile duct at the time of cholecystectomy, which is safe and readily mastered. It is hoped that LCBDE will be adapted to laparoscopic surgeons so patients can undergo a single procedure to remove their gallstones and common bile duct stones if they exist and to decrease the incidence of normal preoperative ERCPs, the complications related to ERCP, and the need for a second procedure postoperatively to clear stones if they are found. Nobody can submerge the importance & need for ERCP particularly in retained stones even after LCBDE. Keywords: Laparoscopic Cholecystectomy, Choledocholithiasis, common bile duct, stone, exploration. Author Address: Shahram Nazari, MD. Consultant & Lecturer in Surgery, Department of General and Laparoscopic Surgery, Erfan Hospital, Tehran, Iran. No:36, Afarin St.,Alvand Ave.,Argentin Sq.,Tehran 1516636111,IRAN. Tell: (+98-21)88884610 & (+98-21)88884652 Tell Fax: (+98-21)88678159 Cell phone: (+98)9141156308 & (+98)9121583700 Site: www.shahramnazari.com Email: dsnazari@hotmail.com.com

Endoluminal Surgery, New target for Hybrid Endo-Laparoscopic surgeon

Shahram.Nazari, MD1
(1)Department of Surgery, Erfan Hospital, Tehran, Iran
Although surgery within the lumen of the gut has been performed for many years, this has traditionally involved a laparotomy and enterotomy. Intraluminal surgery began with the advent of endoscopy. With the advances in flexible endoscopy, surgeons and gastroenterologists have been able to perform therapeutic procedures with instruments introduced through the working channel of flexible endoscopes. These procedures, however, have been mainly limited to technically minor ones, such as injection and cautery of bleeding ulcers and resection of polyps and small mucosal lesion (EMR & ESD). After the advent of Trans-Endoscopic Mucosectomy (TEM), intraluminal surgery developed. More recently, laparoscopic surgeons have been able to isolate the lumen of hollow organs as a separate working space. Laparoscopy-assisted intraluminal surgery is a novel alternative to open or laparoscopic surgery for a failed endoscopic endoluminal technique, minimizing the associated complications. Endoscopic resection of early cancers is restricted by the limited view of the endoscope, insufficient number of instrument channels, and inability to have adequate margins of resection without risking perforation. These cancers potentially can be treated by laparoscopy-assisted intraluminal surgery without resorting to major resection. This procedure is relatively easy to perform and oncologically effective. We present our experience in laparoscopy-assisted endoluminal surgery.
Author Address:
Shahram Nazari, MD. Consultant & Lecturer in Surgery, Department of General and Laparoscopic Surgery, Erfan Hospital, Tehran, Iran. No:36, Afarin St.,Alvand Ave.,Argentin Sq.,Tehran 1516636113,IRAN.
Tell: (+98-21)88884610 & (+98-21)88884652
Tell Fax: (+98-21)88678159
Cell phone: (+98)9141156308 & (+98)9121583700
Site: www.shahramnazari.com Email: dsnazari@hotmail.com.com

Power point presentation

Laparoscopic Common Bile Duct Exploration

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