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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
Thu Jun 30 2022
Journal Name
Journal Of Economics And Administrative Sciences
Examining the Asymmetric Impacts of Interest and Exchange Rate on Investment in Egypt for the Period 1976-2020: Applying NARDL Model
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Most of the studies conducted in the past decades focused on the effect of interest rates and exchange rates on domestic investment under the assumption that the independent variables have the same effect on the dependent variable, but there were limited studies that investigated the unequal effects of changes in interest rates and exchange rates, both positive and negative, on domestic investment.  This study used a nonlinear autoregressive distributed lag (NARDL) model to assess the unequal effects of the real interest rate and real exchange rate variables on domestic investment in Egypt for the period 1976 - 2020.  The results revealed that positive and negative shocks for both exchange rates have unequal effects on

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Publication Date
Mon Mar 13 2017
Journal Name
Journal Of Baghdad College Of Dentistry
Comparative Study of The Amount of Apically Extrusion Of Debris During Root Canal Preparation Using Wave Oneâ„¢, Trushape 3Dâ„¢, Hyflexâ„¢ CM and One Shapeâ„¢ Instrumentation Systems (An In Vitro Study)
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Background: Many types of instruments and techniques are used in the instrumentation of the root canal system. These instruments and techniques may extrude debris beyond the apical foramen and may cause post-instrumentation complications. The aim of this study was to evaluate the amount of apically extruded debris resulted by using 4 types of nickel-titanium instruments (WaveOne, TRUShape 3D conforming files, Hyflex CM, and One Shape files) during endodontic instrumentation. Materials and methods: Forty freshly extracted human mandibular second premolar with straight canals and a single apex were collected for this study. All teeth were cut to similar lengths. Pre-weighted glass vials were used as collecting containers. Samples were randoml

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Publication Date
Thu Jan 30 2025
Journal Name
Iraqi Journal Of Agricultural Sciences
FIRST RECORD OF RED ALGAE POLYSIPHONIA SUBTILISSIMA (MONTAGNE, 1840) (FAMILY: RHODOMELACEAE) COLLECTED FROM KARACHI COAST PAKISTAN (NORTHERN ARABIAN SEA).
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This study presents a detailed morphology and taxonomic study of Polysiphonia subtilissima collected from Abdul Rehman Goth, Karachi coast, Pakistan. Polysiphonia is a filamentous heterotrichous red algae, characterized by its branching structures and attachment mechanisms. P. subtilissima is notable for its broad salinity tolerance and wide distribution across marine and freshwater ecosystems. This research provides an in-depth examination of the internal and external structures of P. subtilissima, contributing to its systematic study and documenting its first recorded occurrence in Pakistani coastal areas, bordering the northern Arabian Sea. The findings enhance the understanding of the species taxonomy and its ecological role in

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Publication Date
Fri Aug 30 2019
Journal Name
Journal Of The College Of Education For Women
A Cognitive Linguistic Study of the English Preposition 'in'
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The present study aims at analyzing the polysemy of the English preposition in from the cognitive linguistic (CL) point of view using Evans' and Tyler's approach (2003). The perplexity faced by Iraqi second language learners (L2) due to the multi-usages of this preposition has motivated the researcher to conduct this study. Seventy-six second year university students participated in this experimental study. The data of the pre-test and post-test were analyzed by SPSS statistical editor. The results have shown the following: First, a progress of more than (0.05≤) has been detected as far as students' understanding of the multiple usages of the preposition in is concerned. Second, the results of the questionnaire have s

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Publication Date
Thu Sep 10 2020
Journal Name
Journal Of Advances In Mathematics
A Study of The Density Property in Module Theory
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In this paper, there are two main objectives. The first objective is to study the relationship between the density property and some modules in detail, for instance; semisimple and divisible modules. The Addition complement has a good relationship with the density property of the modules as this importance is highlighted by any submodule N of M has an addition complement with Rad(M)=0. The second objective is to clarify the relationship between the density property and the essential submodules with some examples. As an example of this relationship, we studied the torsion-free module and its relationship with the essential submodules in module M.

Publication Date
Thu Dec 31 2015
Journal Name
مجلة كلية العلوم الاسلامية
The Secret of Marriage in Christianity A Descriptive Study
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Marriage is a holly secret in Christian religion .So it id natural that its ceremonies acquired religious form .In general the marriage is contracted by minister of religion in presence of the two parties or by a proxy or presence of parents if it is necessary . And to make the condition of publicity for the marriage ,its procedures must be made before witnesses .Also the minister of religionhave to confirm the agreement of the two parties before beginning the procedures.The marriage ceremonies are made.These procedures are religious traditions that includes praying and make blessings and putting the rings in fingers by thepriest . The marriage is a holly secret performed by the crown pray according to the church religious traditions

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Publication Date
Wed May 15 2024
Journal Name
International Journal Of Religion
The Theory of Quantity in Measures and Scales a Comparative Jurisprudential Study
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Every body has a size and mass that distinguishes it from others and makes it different from others. Some of these bodies are huge and large in size, and some are small and light in weight. Among these masses and bodies are some that are dealt with by their size and weight, each according to its quantity, weight, and cheapness. This is why they created quantities by which these weights and quantities could be estimated, so they used measures and weights for that. Objectives: The research aims to know some measures and weights, such as the wife’s maintenance, the amount of zakat, etc.I found it to be a widely spread topic, and widely used in the folds of jurisprudence. During my reading of jurisprudence books, I found jurists using many qu

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Publication Date
Wed Nov 03 2021
Journal Name
Al-ghary Journal Of Economic And Administrative Sciences
The Role of Marketing Vigilance in Analyzing the Strategic Position of Tourism Organization: A Survey Study of the Opinions of a Sample of Travel and Tourism Companies
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The study aims at studying and analyzing the subject of marketing vigilance as it is one of the modern approaches in the marketing field that can be used to face changes in the competitive and strategic environment and that represents quick reactions on the part of the institution to ensure its survival and distinctiveness other aims are: Consolidating the strength of the marketing organization and its success continuously, represented by changes in the market share, awareness of the institution's position in the market and its relations with competing tourism companies, diversification of tourism services, as well as an analysis of the competitive strategic position of tourism institutions for the purpose of conducting a r

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Publication Date
Tue Jan 08 2019
Journal Name
Iraqi Journal Of Physics
Effect of plasma jet on the water and hydrogen peroxide that used for assisted teeth bleaching
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In this work the interaction of plasma jet with water and hydrogen peroxide liquids used for assisted teeth bleaching by plasma jet had been study. A homemade plasma jet system was used. The plasma jet supply by 15 W electrical power generated by high voltage power supply of 9.6 kV peak to peak and frequency of 33 kHz .this power supply generate high electric field on electrodes that would be enough to ionize the argon gas. Some important agents were study such as the effect of the Ar gas flow rates on the length of the plasma jet, the influence of plasma jet on some properties of water and two hydrogen peroxide concentrations 25 % and 30 % like pH, conductivity and liquid temperature for different exposure time. The liquids temperature

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Publication Date
Wed Jun 03 2020
Journal Name
Political Sciences Journal
Transitional justice: a study of the concept and mechanisms
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The concept of transitional justice is newly emerging, as it was mainly associated with addressing issues of serious breaches and abuses of human rights during conflicts and situations resulting from violence and the use of force in societies that are in the process of democratization, as transitional justice aims primarily to restore civil peace and rebuild institutions The state needs multidimensional justice: a judicial system that achieves the rule of law, corrective restoration of the wounds of the past, and a distributive characteristic of the redistribution of wealth.

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