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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
Fri Jun 30 2023
Journal Name
نسق
the effect of the semantic map strategy on predictive thinking among fifth grade femal students
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Publication Date
Sun May 10 2015
Journal Name
Al-academy
Intellectual Reflections of the Cubical Arts on the Iraqi Contemporary Pottery Art: أحمد جعفر حسين
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The current study discusses one of the most important modern schools in art, and it studies its impact on contemporary Iraqi art, particularly in the art of pottery because of its association to the utilitarian function. However, this study demonstrated that pottery is a unique art, which has exceeded the limits of this function. In addition, pottery has a great role in changing the view and understanding of it. Therefore, this art assists in achieving the concepts, philosophies, and values among other fine arts branches.The most prominent issues in this article is dealing with reflections of the cubical arts on the Iraqi contemporary pottery art by through the works of the most prominent contemporary artists such as (Saad Shakir, SHania

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Publication Date
Wed Sep 01 2021
Journal Name
Journal Of Engineering
The Effect of Adding High-Density Polyethylene Polymer on the Engineering Characteristics for Sandy Soil
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The loose sand is subject to large settlement when it is exposed to high stresses. This settlement is due to the nature of the high drainage of sand, which displays foundations and constructions to a large danger. The densification of loose sandy soils is required to provide sufficient bearing capacity for the structures. Thus soil stabilization is used to avoid failure in the facilities. Traditional methods of stabilized sandy soil such as fly ash, bituminous, and cement often require an extended curing period. The use of polymers to stabilize sandy soils is more extensive nowadays because it does not require a long curing time in addition to being chemically stable. In this study, the effect of adding different percent

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Publication Date
Wed May 10 2023
Journal Name
Journal Of Engineering
Effect of the Iranian Seperation Dikes on the Water Salinity Patterns Within Al Huweizah Marsh
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Al Huweizah Marsh is considered as the largest marsh at the southern part of Iraq. About one third of the marsh is located within the Iranian territory. Iran began to construct earth dikes along the Iraqi-Iranian international borders to separate the Iranian part of the marsh. The electrical conductivity, EC, value was adopted to be the indicator for the water salinity within the marsh. A steady two-dimensional water quality routing model was implemented by using the RMA2 and RMA4 softwares within the SMS computer package to estimate the distribution of the
EC values within the marsh seasonally during the wet, moderate and dry water years. The EC distribution Patterns were estimated considering the expected two cases of the marsh futu

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Publication Date
Mon Dec 11 2017
Journal Name
Al-khwarizmi Engineering Journal
ptimization the Parameters of Magnetic Abrasive Process Using Taguchi Method to Improve the Surface Roughness
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Abstract  

Magnetic abrasive finishing (MAF) process is one of non-traditional or advanced finishing methods which is suitable for different materials and produces high quality level of surface finish where it uses magnetic force as a machining pressure. A set of experimental tests was planned according to Taguchi orthogonal array (OA) L27 (36) with three levels and six input parameters. Experimental estimation and optimization of input parameters for MAF process for stainless steel type 316 plate work piece, six input parameters including amplitude of tooth pole, and number of cycle between teeth, current, cutting speed, working gap, and finishing time, were performed by design of experiment

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Publication Date
Tue Jan 01 2019
Journal Name
Energy Procedia
Studying the effect of adding buffer gases to CO2 gas on the electron transport parameter
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Publication Date
Tue Jun 01 2021
Journal Name
مجلة جامعة الانبار للعلوم البدنیة والریاضیة
The effect of the flipped classroom on cognitive achievement Some basic football skills for students
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The aim of the research is to design a test with cognitive achievement through the use of the inverted class strategy for some basic soccer skills for gyms for first-average students, within the curriculum of the Ministry of Education, where the researcher used the experimental approach. For the same division (B) and the number of each group (10) students, i.e. the total total of the research sample (20) students, and the pre-test for the research sample was applied through the design of the test prepared by the research after which the educational program with the strategy was applied to the research sample and continued (8) weeks after Completion of the tutorial has been post-tested for the research sample, In it, he reached significant r

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Publication Date
Sat Jun 01 2019
Journal Name
Journal Of Accounting And Financial Studies ( Jafs )
Measuring the Performance of IT Governance According to COBIT5 Framework by Using the Balanced Scorecard
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The research aims to clarify the COBIT5 framework for IT governance and to develop of a criterion based on Balanced Scorecard that contributes in measuring the performance of IT governance. To achieve these goals, the researchers adopted the deductive approach in the design of balanced scorecard to measure the IT governance at the Bank of Baghdad that was chosen because it relied heavily on IT.

The research has reached a number of conclusions, the most important of which is that the performance of IT department in the Bank of Baghdad falls within the good level that requires constant monitoring, the most committed items of Balanced Scorecard by the Bank were customer, internal operation, growth and finally the financial item; IT

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Publication Date
Sat Sep 30 2023
Journal Name
Misan Journal For Academic Studies
The microhardness Property of the Biomedical commercially pure titaniumstrontium oxide composite alloy after anodic oxidation
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Publication Date
Fri Jan 01 2016
Journal Name
Journal Of Engineering
Improve the Performance of PID Controller by Two Algorithms for Controlling the DC Servo Motor
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The paper uses the Direct Synthesis (DS) method for tuning the Proportional Integral Derivative (PID) controller for controlling the DC servo motor. Two algorithms are presented for enhancing the performance of the suggested PID controller. These algorithms are Back-Propagation Neural Network and Particle Swarm Optimization (PSO). The performance and characteristics of DC servo motor are explained. The simulation results that obtained by using Matlab program show that the steady state error is eliminated with shorter adjusted time when using these algorithms with PID controller. A comparative between the two algorithms are described in this paper to show their effectiveness, which is found that the PSO algorithm gives be

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