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The Surgical outcomes of fundus-first technique in lowering the rate of bile duct injuries and bleeding during open cholecystectomy that facing intraoperative difficulties: A single-center prospective study: The surgical outcomes of open fundus-first cholecystectomy technique.
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Background: The problem of difficult gallbladder is not clearly defined and associated with real missing of therapeutic approaches that decreased morbidity. Moreover, the difficult gallbladder was reported as a contributing risk factor for biliary injury due to raised difficulty in surgical dissection within Calot’s triangle. The aim of this study is to determine the surgical outcomes of the open fundus-first cholecystectomy in lowering the rate of lethal intraoperative risks.

Subjects and Methods: Our prospective study conducted during the period of January 2019 to December 2022 at Ibn Sina specialized hospital, Khartoum, Sudan, for two hundred and fifty-three patients underwent elective open fundus-first cholecystectomy for intraoperative difficulties.

Results: the majority of cases had long-standing cholelithiasis with intraoperative difficulties revealed by pre-operative TUS and MRCP which required open fundus-first cholecystectomy in 173 (68.4%) of patients, (P-value <0.05). The operative surgical time was 120 minutes in 103 patients (40.7%), (P-value <0.05). During open cholecystectomy, variable intraoperative difficulties were found in all patients, (P-value <0.05) and were divided into: (A) Contracted intra-hepatic gallbladder seen in 157 (62.1%) of cases; (B) Distorted anatomy within Calot's triangle seen in 135 (53.4%) of patients; and (C) Intraoperative bleeding from the liver bed was observed as bloody oozing form in 150 (59.3%) of cases. Our patients had minimal postoperative complications like mild wound infection in 8 (3.2%) of cases and mortality rate was zero. 

Conclusions: There is a need for appropriate therapeutic and preventive strategies in healthcare systems for safe dealing with difficult cholecystectomy. Unclear anatomy due to severe inflammatory dense adhesions at Calot’s triangle and CBD stones needing difficult surgeries are the most important limiting factors for fundus-first laparoscopic cholecystectomy. Hence, we humbly recommend an open approach of fundus-first cholecystectomy as safe surgical option to reduce the incidence of bile duct injuries and intra-operative bleeding.

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Publication Date
Mon Feb 01 2016
Journal Name
Journal Of Economics And Administrative Sciences
International variables and their impact on the flow of foreign direct investment in Gulf Cooperation Council (GCC)
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Abstract:

The six Arab Gulf states (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, UAE) play a vital role, especially with its geographical location and natural  resources (oil and gas) as well as other cultural and civilizational elements, in achieving  global economic balance and more specifically global energy security, naturally  because of  these countries have a comparative advantage in the field of fossil energy (oil and gas), thus this sector becomes more attractive for local and international investments alike. Being  the energy sector a leader sector in the economic development process, and the basic factor to achieve savings and financial surpluses in thes

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Publication Date
Thu Jun 01 2023
Journal Name
Journal Of Engineering
Analysis of Traditional and Fuzzy Quality Control Charts to Improve Short-Run Production in the Manufacturing Industry
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Quality control charts are limited to controlling one characteristic of a production process, and it needs a large amount of data to determine control limits to control the process. Another limitation of the traditional control chart is that it doesn’t deal with the vague data environment. The fuzzy control charts work with the uncertainty that exists in the data. Also, the fuzzy control charts investigate the random variations found between the samples. In modern industries, productivity is often of different designs and a small volume that depends on the market need for demand (short-run production) implemented in the same type of machines to the production units. In such cases, it is difficult to determine the contr

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Publication Date
Mon Jul 01 2024
Journal Name
Civil Engineering Journal
The Effect of Oil Contaminated on Collapse Pattern in Gypseous Soil Using Particle Image Velocimetry and Simulation
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Gypseous soil covers approximately 30% of Iraqi lands and is widely used in geotechnical and construction engineering as it is. The demand for residential complexes has increased, so one of the significant challenges in studying gypsum soil due to its unique behavior is understanding its interaction with foundations, such as strip and square footing. This is because there is a lack of experiments that provide total displacement diagrams or failure envelopes, which are well-considered for non-problematic soil. The aim is to address a comprehensive understanding of the micromechanical properties of dry, saturated, and treated gypseous sandy soils and to analyze the interaction of strip base with this type of soil using particle image

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Publication Date
Wed Jan 23 2019
Journal Name
Journal Of Accounting And Financial Studies ( Jafs )
The importance of cash flow statement in reducing credit risk and liquidity: بحث تطبيقي في مصرف الرشيد
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Banks face different types of banking risks that limit the performance of its functions and achieve its objectives, including the financial risk that is based on current research into two types including a credit and liquidity risks. And established credit risk due to the possibility of delaying the borrowers to fulfill their obligations to the bank when due or non-payments on according to the terms agreed upon, while liquidity risk arises as a result of the inability of the bank to fund the financial needs, any inability to provide cash to pay its obligations short on credit without achieving tangible loss or the inability to employ the funds properly and show the liquidity risk in the event of inadequate cash inflows to the bank for an

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Publication Date
Tue Nov 26 2019
Journal Name
Journal Of Engineering
The Experimental Assessment of R134a and Its Lower GWP Alternative R1234yf in an Automobile Air Conditioning System
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Reducing global warming potential (GWP) of refrigerants is needed to the decrease of ozone-depleting of refrigeration systems leakages. Refrigerant R1234yf is now used to substitute R134a inside mobile air conditioning systems. Thermodynamic properties of R1234yf are similar to R134a. Also, it has a very low GWP of 4, compared to 1430 for R134a, making it a proper choice for future automobile refrigerants. The purpose of this research is to represent the main operating and performance differences between R1234yf and R134a. Experimental analysis was carried out on the automotive air conditioning system (AACS) with 3 kW nominal capacity, to test and compare the performance of R134a with R1234yf. Experiments were accomplish

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Publication Date
Thu May 18 2023
Journal Name
J Pure Appl Microbiol.
The Immunohistochemical Staining of Vimentin and E-Cadherin in Bladder Cancer Patients Infected with Hepatitis C Virus
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The invasion and spread of cancer cells are two of the most notable characteristics of malignant tumors. Recent studies suggest that the epithelial-mesenchymal transition (EMT) has been linked to this significant occurrence. It is linked to the absence of the epithelial brow and the presence of mesenchymal facial hair. The aims of the present study were to explore the immunohistochemical staining of vimentin and E-cadherin ex vivo as EMT markers and assess their potential as predictive biomarkers for transitional cell cancer (TCC). In this study, 55 paraffin-embedded biopsies from TCC patients and 10 autopsies that appeared to be normal were included. Immunohistochemistry was used to produce patterns of vimentin and E-cadherin expression. W

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Publication Date
Mon Dec 23 2019
Journal Name
Iraqi Journal Of Pharmaceutical Sciences ( P-issn 1683 - 3597 E-issn 2521 - 3512)
Evaluate the Protective Effect of Lactobacillus against Collateral Damage Induced by Ciprofloxacin and Levofloxacin in Iraqi Patients
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Abstract:                                                                                                                Fluoroquinolones drugs are an important class of wide

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Publication Date
Sat Dec 06 2008
Journal Name
Al-nahrain Journal Of Science
Study of Comets Composition and Structure
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The present paper focuses on the nature of the different interactions between cometary nucleus and tail with solar wind. The dynamics of the comet will impose many features that provide unique behavior of the comet when entering the solar system. These features are reviewed in this paper and few investigations are made. The calculations made in this work represent the analysis and interpretation of the different features of the comet, such as perihelion and eccentricity dependence on the gas production rate, and the dependence of the latter on the composition of the comet nucleus. The dependences of the heliocentric, bow shock, contact surface, and stand-off distances with gas production rate for many types of comets that cover linear and n

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Publication Date
Mon Dec 28 2020
Journal Name
Journal Of The College Of Education For Women
Preparing the Arabic Language Teacher for Non-Native Speakers, Following the Experience of the Arabic Language Institute at the International University of Africa: منى يوسف محمَّد وقيع الله
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The study aims to examine the reality of preparing the Arabic language teacher for non-native speakers by presenting the experience of the Arabic Language Institute at the International University of Africa. Thus, it addresses the following questions: How is it possible to invest the long scientific experiences in proposal and experiment preperations to qualify Arabic language teachers for non-native speakers? What is the reality of preparing an Arabic language teacher at the Institute? How did the Arabic Language Institute process teacher preparation? What are the problems facing the preparation of the Arabic language teachers and the most important training mechanisms used in that Institute?What problems faced the implementation of the

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Publication Date
Sun Mar 01 2020
Journal Name
Sustainable Chemistry And Pharmacy
A sustainable approach to utilize olive pips for the sorption of lead ions: Numerical modeling with aid of artificial neural network
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