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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 Sep 30 2022
Journal Name
Journal Of Economics And Administrative Sciences
Comparison of Some Methods for Estimating the Survival Function and Failure Rate for the Exponentiated Expanded Power Function Distribution
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       We have presented the distribution of the exponentiated expanded power function (EEPF) with four parameters, where this distribution was created by the exponentiated expanded method created by the scientist Gupta to expand the exponential distribution by adding a new shape parameter to the cumulative function of the distribution, resulting in a new distribution, and this method is characterized by obtaining a distribution that belongs for the exponential family. We also obtained a function of survival rate and failure rate for this distribution, where some mathematical properties were derived, then we used the method of maximum likelihood (ML) and method least squares developed  (LSD) to estimate the parameters an

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Publication Date
Sun Sep 01 2013
Journal Name
Journal Of Economics And Administrative Sciences
Sustainable Tourism development and its contribution in facing unemployment phenomenon
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Tourism is a human phenomenon and economic and social activity. It represents an effective forces in the life of the individuals and state alike. As any other economic and human activity has appositive and negative results.

So there is a necessary to planning and activate this sector to get the most possible advantage.

Tourism  has special importance out of its effect on the structure  and performance of national economy. It can be regarded a dynamic activity with mutual effect include all the economic activities within and out the state. Tourism is affected and affect the  production con summing , joineries , communication , ports ,hotel , restaurants ,internal and

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Publication Date
Tue Dec 29 2020
Journal Name
Iraqi Journal Of Pharmaceutical Sciences ( P-issn 1683 - 3597 E-issn 2521 - 3512)
Medication Safety in Patients under 18 Years Old; a Retrospective Study based on Iraqi Pharmacovigilance Center Database
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Medication safety is an important part of the comprehensive patient safety term. Medication safety is gaining more attention as the World Health Organization set the goal of decreasing medication harm by (50%) for the next 5 years when launching the third global challenge. Studying medication safety in the risk groups such as young ages, children are crucial to learn more about the effect of medicines in this risk group since they are not included in the clinical trials. Adverse drug reaction is defined as any harm resulted from the drug itself during medical process journey, while medication errors are any harm resulted from the treatment process rather than the drug or it is the result of the failure in a step of the treatment process

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Publication Date
Tue Jun 01 2021
Journal Name
Political Sciences Journal
The role of elections in solidifying the process of democratization: a case study of Tunisian elections in 2019
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The electoral mechanism is remarkably clear, a political tool for institutional construction, directing political life, forming the political scene, and forming the partisan scene. This process was through the design of electoral laws, as elections in Tunisian political history represented the indicator of its slow and accelerated transformations, so The elections in Tunisia usually coincide with important political stages, accompanied by legislative or constitutional amendments in general, Islamic or secular forces have played a fundamental role in promoting the democratic experience and the principle of the peaceful transfer of power. This led to the formation of a national consensus that would help the country not enter into political

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Publication Date
Sun May 01 2022
Journal Name
Journal Of Engineering
Comparative Study between the Behavior of the Concrete Thrust Block and the Restraint Joint in a Water Distribution System; Review
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Thrust blocks and restraint joints are the two most popular methods of counteracting the thrust force that generated at pipe fittings (bends, Tee, wye, reducers, dead ends, etc…). Both systems perform the same function, which is to prevent the joints from separating from the pipes. The aim of the study is to review previous studies and scientific theories related to the study and design of thrust blocks and restraint joints to study the behavior of both systems under thrust force and to study the factors and variables that affect the behavior of these systems. The behavior of both systems must be studied because they cannot be abandoned, as each system has conditions whose use is more feasible, scientific, and economic

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Publication Date
Wed Jun 20 2018
Journal Name
Al-academy
Directed by Treatment for single-place events in the cinematographic medium
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The cinematographer mediates through the means of cinema and television a set of elements complementing each other in the light of developments in various sciences, culture and arts for the purpose of conveying the meaning to the recipient and achieve aesthetic taste. Despite the diversity of cinematographic media with its multiple forms, The researcher started from the principle of definition and knowledge of a technical phenomenon that emerged in the cinematographic medium through the treatment of dramatic events through the solutions of the exit line depends on the narrative of events in one place contributes to attract Mam spectator since this interesting phenomenon in the mediator, there .van question arises the adoption of that vis

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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
Sun Aug 12 2018
Journal Name
Iraqi Journal Of Market Research And Consumer Protection
ISOLATION AND IDENTIFICATION OF PSEUDOMONAS SP THAT PRODUCE LIPASE: ISOLATION AND IDENTIFICATION OF PSEUDOMONAS SP THAT PRODUCE LIPASE
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15 local isolates of Pseudomonas were obtained from 35 samples from several sources such as soil, water and some high-fat foods. The ability of isolates to produce lipase was measured by the size of the clarification zone formed around the colonies on the lipase production medium and by measuring the enzymatic activity and specific enzymatic activity, the isolate M3 was found to be the most efficient for production of the enzyme, This isolate was identified by microscopic, morphological, some biochemical tests and genetic diagnosis of 16S gene sequences by using the (PCR) technique, and then comparing the results obtained with the National Center for Biotechnology Inform

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Publication Date
Mon Sep 01 2025
Journal Name
Dirasat: Human And Social Sciences
‎“Parents Who Cause Harm”: A Study of the Attachment Theory in Christopher Durang’s ‎‎‘The Marriage of Bette and Boo’‎
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  Objectives: This study aims to examine toxic parental behavior and its impact on children based on the attachment theory. It also explores how early parental relationships influence future relationships with partners and children. The research assesses types of toxic parenting (dysfunctional, harmful, and psychologically damaging parenting behaviors) and their resulting insecure attachment patterns—avoidant, ambivalent, and disorganized—through the characters in The Marriage of Bette and Boo. Methods: Toxic parents play a decisive role in children’s lives, affecting how they view themselves and impacting their behavior. The study uses a psychological evaluation method that relies on the attachment theory (1978), first prese

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Publication Date
Sun Jan 01 2023
Journal Name
Revista Iberoamericana De Psicología Del Ejercicio Y El Deporte
THE IMPACT OF ENGINEERING ANXIETY ON STUDENTS: A COMPREHENSIVE STUDY IN THE FIELDS OF SPORT, ECONOMICS, AND TEACHING METHODS
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