این کنگره علمی توسط انجمن جراحان ایران برگزار شده است. هدف اصلی این کنگره و کنفرانس های علمی آن ایجاد فضایی علمی جهت تبادل اطلاعات بین جراحان سنتی و جراحان آندوسکوپیک لاپاروسکوپیست ایران میباشد.
در این کنگره علمی سعی بر این است که آخرین دستاوردها و تکنولوژیهای جراحی های سنتی (باز) و جراحی های آندوسکوپیک -لاپاروسکوپیک در جراحی ارائه شود و اطلاعات علمی و کاربردی مفیدی از یافتههای اخیر جراحی در اختیار شرکت کنندگان قرار گیرد. در این راستا، سخنرانیهای متعددی توسط جراحان متخصص و برجسته داخلی و خارجی در زمینه جراحی های مختلف من جمله لاپاروسکوپی ایراد شد. همچنین دورههای فشرده تخصصی، جلسات بحث و گفتگو و ارائههای ویدیویی نیز از برنامههای دیگر این کنفرانس علمی آموزشی بوده است.
دکتر نظری در این کنگره شرکت فعال داشتند و در تعامل با دیگر جراحان از سراسر ایران، از پیشرفتهای روز جراحی اطلاع حاصل کردند.
ایشان در تاریخ ۱۳۹۲/۲/۱۶ ارایه مقاله و فیلم ویدیویی تحت عنوان
Laparoscopic Common Bile Duct Exploration;New target for the surgeon, New opportunity for the patient. Does it stand against ERCP?
داشتند.
Laparoscopic Common Bile Duct Exploration, New targets for the surgeon.
Does it stand against ERCP?”]
Shahram.Nazari, MD1
(۱)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 690 patients treated over 56 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 68 patients by routine IOC. For 7 patients, ERCP was performed. LCBDE was done in 61 patients; all LCBDEs were completed laparoscopically. In 21 patients, CBD closed on a C-Tube and in 10 patients LCBDE completed with T-tube insertion. In 6 cases no CBD drainage was performed. In 60 cases flexible choledochoscopy was done. Choledochoduodenostomy was performed in 24 cases. The mean operative time was 90-130 minutes (mean 95), which is significantly greater than conventional LC (range 20-40 minutes, mean 30). LCBDE was performed without immediate or late 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 adopted 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.
Keywords:Laparoscopic Cholecystectomy, Choledocholithiasis, common bile duct, stone, exploration.