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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
Wed Jan 01 2014
Journal Name
Department Of Bioengineering And Sciences
1 T.R. KAHRAMANMARAŞ SÜTÇÜ İMAM UNIVERSITY GRADUATE SCHOOL OF NATURAL AND APPLIED SCIENCE Cloning and overexpression of Lactobacillus acidophilus bile salt hydrolase A gene (bshA) in Escherichia coli
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The bile salt hydrolase gene (bshA), encoding bile salt hydrolase enzyme (EC 3.5.1.24) from probiotic isolate Lactobacillus acidophilus Ar strain which is responsible for assimilation cholesterol were studied in the present work. About 801 bp in length DNA fragment of Lb. acidophilus Ar strain was amplified by PCR techniques. Two restriction sites (PstI/SacI) were added to each end of that fragment for manipulation of DNA during cloning. Amplified fragment inserted into pJET1.2\blunt end vector and pMG36e vector respectively. pJET1.2\blunt end vector is overexpression plasmid for E. coli MC1022, and pMG36e vector is a shuttle vector which is able to replicate in both E. coli and lactic acid bacteria. The resulted constructs were named as pJ

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Publication Date
Wed Jan 15 2020
Journal Name
Journal Of Accounting And Financial Studies ( Jafs )
The responsibility of the administration in compliance with the going concern assumption during the preparation for their financial statements: Research practically at muster of companies
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This research aims to demonstrate the impact of the going concern assumption in different accounting applications to provide a realistic look and more accurate result of activity and financial situation, as well as determining the responsibility of the Company's administration in compliance with the going concern assumption during the preparation for their financial statements, and to clarify the concept of integration between internal audit and external audit about going concern assumption, besides its importance and usefulness on the work of both of the internal auditor and the external auditor, as well as on the company under auditing process.This research purports preparing an internal audit program, including a set of auditing actio

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Publication Date
Sat May 29 2021
Journal Name
Journal Of Legal And Political Thought
The extent of the possibility of compensating for the obstruction of the view (vision) as a result of the establishment of public projects - a legal study in light of the position of the American courts
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Despite the great economic and commercial importance given to real estate by virtue of its view of the landscape or public roads, US courts have differed in their position on compensation for damages resulting from blocking that view or vision by public projects. Some courts compensated for such damages, other courts approved such compensation. Hence, this research came to shed light on the extent of the possibility of compensation for blocking the view or vision as a result of public projects, and the research has supported us with many judicial decisions.

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Publication Date
Wed Jun 07 2023
Journal Name
Journal Of Educational And Psychological Researches
Problems Facing University Students in Distance Learning
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The current study aims to examine the level of problems faced by university students in distance learning, in addition to identify the differences in these problems in terms of the availability of internet services, gender, college, GPA, interactions, academic cohort, and family economic status. The study sample consisted of (3172) students (57.3% females). The researchers developed a questionnaire with (32) items to measure distance learning problems in four areas: Psychological (9 items), academic (10 items), technological (7 items), and study environment (6 items). The responses are scored on a (5) point Likert Scale ranging from 1 (strongly disagree) to 5 (strongly agree). Means, standard deviations, and Multivariate Analysis of Vari

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Publication Date
Sat Dec 01 2018
Journal Name
Journal Of Accounting And Financial Studies ( Jafs )
Use ofBang marking in the management of the cost of food and beverages in the hotel: sector (Case study in a sample of hotels in Baghdad governorate)
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The competition in the hotel sector, globalization and the development of new information have forced the sector to continuously seek new techniques and arrangements to remain competitive through hotel industry companies, including Benchmarking and the application of this method in the hotel sector. The selection of the Rashid International Hotel by the Ministry of Tourism as a leading hotel or benchmark for comparison of other hotels in Iraq, and the selection of two hotels in Baghdad for comparison, namely (Ishtar International Hotel, Baghdad International Hotel) and the choice also by the Ministry of Tourism, N is to correct the course of practice to manage the cost and diagnosis of the weakness of the strengths and weaknesses in the

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Publication Date
Sat Aug 09 2025
Journal Name
Al–bahith Al–a'alami
The Problemic of the ambiguous relationship between the media and terrorism, and the problems arising from… An exploratory study of a sample of journalists, writers and researchers in Baghdad
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This study examined the problematic of the ambiguous relationship between the media and terrorism and the problems that result from press coverage of terroristic incidents. The paper sought to show the classification and confrontation of such incidents had been established from the point of view of a sample of media professionals, researchers and writers who are frequenters of Al-Mutanabi Street in Baghdad. The media outlets that carry this coverage would not give up their media mission as well as the terrorists would not be given an opportunity to take advantage of this coverage in achieving their goals and objectives. Furthermore, the terrorist organizations would have no chance to exploit these means to deliver their terroristic messa

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Publication Date
Wed Jun 01 2011
Journal Name
Journal Of The College Of Languages (jcl)
Новые направления и течения начала Серебряного века The Silver Age and the New Trends That appeared at the Twentieth Century.
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    Годы, принадлежащие концу XIX – началу XX столетия, вошли в русскую литературу под красивым названием Серебряный век. В это время в стране появился целый ряд выдающихся поэтов, имена которых навсегда останутся в русской и мировой литературе. Это Ахматова, Гумилев, Блок, Маяковский и многие другие. Все эти люди творили в нелегкое для России время. Началом Серебряного века условно считают 189

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Publication Date
Wed Dec 27 2023
Journal Name
Journal Of Planner And Development
The dynamics of the oil industry in shaping land uses: a case study of the Zubair oil field
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The emergence of oil fields and subsequent changes in adjacent land use are known to affect settlements and communities. Everywhere the industry emerges, there is little understanding about the impact of oil fields on land use in the surrounding areas. The oil industry in Iraq is one of the most important industries and is almost the main industry in the Iraqi economic sector, and it is very clear that this industry is spread over large areas, and at the same time adjoins with population communities linked to it developmentally.

The rapid development and expansion of oil extraction activities in various regions has led to many challenges related to land-use planning and management. Here, the problem of research  arises on th

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Publication Date
Mon Feb 18 2019
Journal Name
Journal Of Accounting And Financial Studies ( Jafs )
The Role of the financial Statements in Achieving of the Banking Supervision: An Applied Study in A sample of Iraqi Banks
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Banks are considered the main basis of financial sector ,so they must be submitted to sound and strict regulatory system and so as to ensure their operations and according to instructions and regulations , in order to maintain the integrity of the banking sector and financial sector in general .One of the importance regulatory tools that are adopted by the Iraqi Central Bank to control over the banks an financial and periodic statements that are provided by the banks in accordance with planned schedules .The financial statements of the banks must reflect clearly and accurately financial situation and the result of their activities during the period in which they represent to achiveing its purposes.So it has the goal of Search is statemen

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Crossref
Publication Date
Wed Sep 20 2023
Journal Name
Scientific Culture
THE REALITY OF THE PARTICIPATION OF FEMALE ENTREPRENEURS IN ACHIEVING THE GOALS OF SUSTAINABLE DEVELOPMENT/ A FIELD STUDY IN BAGHDAD GOVERNORATE
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Abstract In light of the changing conditions that prevail in society, and the intense competition that institutions and countries are forced to face, especially after the opening of markets, and the transformation of the world into what is called a small village, entrepreneurship has emerged as an important tool for dealing with the developments of societies, whether it is related to individual business projects or Economics for national business, leadership was the key to any driving force towards achieving growth. Today, women are no longer captive to a specific orientation, but rather all horizons and fields of work have been opened to them, and they have been able to occupy the most important economic, voluntary, service, and

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