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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
Sat Jul 30 2016
Journal Name
Hepatology
Farnesoid X receptor activation increases reverse cholesterol transport by modulating bile acid composition and cholesterol absorption in mice
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Activation of farnesoid X receptor (FXR) markedly attenuates development of atherosclerosis in animal models. However, the underlying mechanism is not well elucidated. Here, we show that the FXR agonist, obeticholic acid (OCA), increases fecal cholesterol excretion and macrophage reverse cholesterol transport (RCT) dependent on activation of hepatic FXR. OCA does not increase biliary cholesterol secretion, but inhibits intestinal cholesterol absorption. OCA markedly inhibits hepatic cholesterol 7α‐hydroxylase (Cyp7a1) and sterol 12α‐hydroxylase (Cyp8b1) partly through inducing small heterodimer partner, leading to reduced bile acid pool size and al

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Publication Date
Sun Dec 03 2017
Journal Name
Baghdad Science Journal
Comparison among Populations of Mosquitoes Culex quinquefasciatus Say by using Geometric Morphometric Technique from Different Regions of Iraq
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The geometric morphometric technique was used to study the variables in the shape and size wings of different populations of mosquitoes Culex quinquefasciatus from different Iraqi provinces Babylon, Baghdad and Wasit. The results showed that the average of centroid size were 366, 387.5 and 407.4 Micron in Babylon, Baghdad and Kut, respectively. The statistical analysis showed that there were no significant differences in the average of centroid size of all specimens and they belong to the same species.

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Publication Date
Wed Jul 01 2015
Journal Name
Arabian Journal Of Geosciences
Mishrif carbonates facies and diagenesis glossary, South Iraq microfacies investigation technique: types, classification, and related diagenetic impacts
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Publication Date
Tue Dec 01 2020
Journal Name
Journal Of Economics And Administrative Sciences
The role of marketing recovery in improving the organization's reputation An applied study of a sample of private bank managers in Baghdad
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This research aims to know and the role of the marketing recovery dimensions in improving the organization's reputation through an exploratory study of private banks in the city of Baghdad. The aim of the research is to define the role of the marketing recovery through its dimensions (compensation, apology, speed of response, assistance and problem solving), in improving the organization's reputation, as the research will attempt to provide a theoretical framework for the dimensions studied through the most important of what researchers presented and then conduct the applied aspect of the research. Data were collected using a questionnaire-based survey consisting of 35 questions and distributed to 110 managers of private banks in

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Publication Date
Wed Jan 15 2020
Journal Name
Journal Of Accounting And Financial Studies ( Jafs )
The role of credit policies in agricultural development: The activity of co-operative agricultural bank as a case study
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The objective of this study is to explain the role of credit policies in agricultural development of Iraq during the period 1979-1989 which were represented by the policy of co-operative agricultural bank the organization that responsible to finance agricultural sector for various reasons. It has been shown that there was no clear credit policy existed during the period concerned due to the differences between loans from year. The loan growth rate was low in general comparing with objectives of the agricultural development plans, a low production rates comparing with loans paid, the growth rate of average number of trees in each donum and the growth rate of livestock number was also low.In conclusion there should be a clear plan for cred

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Publication Date
Mon Jul 01 2013
Journal Name
Political Sciences Journal
The regional attitude towards the change in the Arab region: turkey as a case study
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This research deals with the nature of the Turkish attitude towards the events of the Arab Spring which the Arab region witnessed recently, as this attitude is characterized by hesitation and utter confusion about those events at its beginning. However, the development of events and the consequent repercussions led the Turkish decision makers of the foreign policy to reconsider their attitude towards those events for political, economic, cultural and social motives.

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Publication Date
Thu Sep 01 2016
Journal Name
Journal Of Engineering
The Effect of Vehicle Body Shapes on the Near Wake Region and Drag Coefficient: A Numerical Study
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The purpose of this paper is to gain a good understanding about wake region behind the car body due to the aerodynamic effect when the air flows over the road vehicle during its movement. The main goal of this study is to discuss the effect of the geometry on the wake region and the aerodynamic drag coefficient. Results will be achieved by using two different shapes, which are the fastback and the notchback. The study will be implemented by the Computational Fluid Dynamic (CFD) by using STAR-CCM+® software for the simulation. This study investigates the steady turbulent flow using k-epsilon turbulence model. The results obtained from the simulation show that the region of the air separation behind the vehicle

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Publication Date
Mon Dec 01 2014
Journal Name
Journal Of Economics And Administrative Sciences
A comparative study of stylistic kriging and Co - kriging Multivariate on the barley crop in Iraq
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  This paper deals  the prediction of the process of  random spatial data of two properties, the first is called  Primary variables  and the second is called secondary  variables ,   the method  that were used in the  prediction process for this type  of data is technique Co-kriging  , the method is usually used when the number of primary variables  meant to predict for one of its elements is measured in a particular location a few (because of the cost or difficulty of obtaining them) compare with secondary variable which is the number of elements  are available and  highly correlated with primary variables, as was the&nbs

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Publication Date
Sun Dec 16 2018
Journal Name
Al-academy
Alienation in Contemporary Sculpture between the Works of Anthony Caro and Tony Cragg (A Comparative Study)
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  • The subject of this research is the study of the formal alienation of contemporary English sculpture, by comparing the most important sculptors of the new contemporary generation. This research problem is to look for the important factors in the formation of the contemporary sculptural structure of the exotic, and what is the mechanism of formation and output of these forms. The research seeks to explore (Alienation in contemporary sculpture between the works of Anthony Caro and Tony Cragg) in a comparative study. The importance of the research is to identify the concept of alien forms in contemporary British sculpture, especially in the cases of Anthony Caro and Tony Cragg that this research is considered a know

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Publication Date
Fri Jan 01 2021
Journal Name
Aip Conference Proceedings
Investigating the correlation of AE-index with different solar wind parameters during strong and severe geomagnetic storms
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