با نهایت احترام به اطلاع همکاران رشتهجراحی میرساند که به یاری خداوند متعال سمینار جراحی دستگاه گوارش و چاقی مفرط (باز و لاپاروسکوپی)با همکاری جامعه جراحان ایران و شاخه ایرانی کالج جراحان آمریکادر 8 بهمن ماه 1393الی 9 بهمن ماه 1393 در محل مرکز همایشهای بین المللی جزیره کیش برگزار شد.
این کنگره علمی توسط جامعه جراحان ایران و با همکاری شاخه ایرانی کالج جراحان آمریکابرگزار شد. هدف اصلی این کنگره و کنفرانس های علمی آن ایجاد فضایی علمی جهت تبادل اطلاعات بین پزشکان متخصص جراحی دستگاه گوارش و چاقی ایران بود.
در این کنگره علمی سعی بر این بوده است که آخرین دستاوردها و تکنولوژیهای طب جراحی دستگاه گوارش و چاقی ارائه شود و اطلاعات علمی و کاربردی مفیدی از یافتههای اخیر طب جراحی دستگاه گوارش و چاقی در اختیار شرکت کنندگان قرار گیرد. در این راستا، سخنرانیهای متعددی توسط پزشکان متخصص و برجسته داخلی و خارجی در زمینه های مختلف طب جراحي من جمله لاپاروسکوپی ایراد شد. همچنین دورههای فشرده تخصصی، جلسات بحث و گفتگو و ارائههای ویدیویی
نیز از برنامههای دیگر این کنفرانس علمی آموزشی بود .
دکتر نظری در این کنگره شرکت فعال دارند و در تعامل با دیگر متخصصین و جراحان از سراسر ایران، از پیشرفتهای روز متخصصین جراحی نیز اطلاع حاصل نمودند.
ایشان در تاریخ 1393/11/8 ارایه مقاله و فیلم ویدیویی تحت عنوان
Laparoscopic Common Bile Duct Exploration
دادند.
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
2 Comments
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Hi
Thank you for your information.
Could you please inform me which pages and images have problem.
Best regards
Nazari