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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 Feb 01 2019
Journal Name
Journal Of Economics And Administrative Sciences
The role of investment climate indicators in stimulating economic growth: a standard study For Malaysia 1990-2016
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In globalization, the world became open area to competition for the attractive of investment, and the abilities of each country to win the confidence of investors depend upon the preparation to optimize circumstances.   The competitiveness is an essential means of expanding the capacity of developed to coexist in an international environment characterized by globalization. While competition describes the market structure, the behavior of investors and business, competitiveness is interested in the evaluation of business performance or countries and compare them in the conditions of competition available in these markets. Regarding Malaysia, which is depend on FDI-Export- Led Growth strategy,  it has taking on diffe

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Publication Date
Sat Nov 09 2019
Journal Name
Acta Medica Iranica
The Prevalence of a Clinically Silent Nephrolithiasis in Baghdad Population: An Initial Ultrasound Screening Study From Iraq
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Abstract- Asymptomatic or clinically silent kidney stones are possibly serious because, in their expected passage, they may cause infection, obstruction and renal impairment. The purpose of this study was to determine the prevalence of silent kidney stones in a sample of Baghdad population and consider how this value could affect the justification for a screening system. To our best knowledge, this is the first study of its kind conducted in Iraq. We investigated 714 consecutive patients who sustained an abdominal ultrasound at our hospital with further kidney screening. All these patients did not have clinical signs and symptoms of nephrolithiasis. Age, sex, the indication for ultrasound, the size, side, and the number of the disco

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Publication Date
Sun Oct 01 2017
Journal Name
Journal Of Economics And Administrative Sciences
The Possibility of Applying Quality Management System ISO9001: 2008 in Station Project Al Rustumiya - A Case Study
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The research study of the possibility of the application of the quality management system under the international standard ISO ISO9001: 2008 in the station project Rustumiya wastewater treatment of the Department of SEWER BAGHDAD - Baghdad MOREALITY as the first step in the right direction towards the implementation of total quality management (TQM), and the research Find the gap between the international standard and the quality system used in the organization surveyed through the use of checklists to analyze the gap, the checklist have included (191) items distributed on five basic requirements, according to the appearance in the international standard, namely, (quality management system, management responsibility, resource man

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Publication Date
Sun Sep 01 2019
Journal Name
Dental Hypotheses
Possible Role of Statins on the Inflammatory Biomarkers in Patients With Periodontal Disease: A Cross-Sectional Study
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The aim of the present study was to demonstrate the possible role of statins on the inflammatory biomarkers in patients with periodontal disease (PD) This cross-sectional study involved 74 patients with PD and/or dyslipidemia divided into Group A: 34 patients with PD (nonstatins users); Group B: 40 patients with PD (statins users); and Group C: 30 healthy controls. Total cholesterol (TC), triglyceride (TG) and high-density lipoprotein, C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and malondialdehyde (MDA) were measured . Blood pressure prolife and indices of PD were evaluated in each group. Statistical analysis was conducted by using SPSS version 20.0.

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Publication Date
Sun Jan 01 2006
Journal Name
Diala Journal For Application Research
Study and calculation of the effects of excessive stress temperatures on the buoyant convection of clouds.
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Recent developments in two main phases of cumulus cloud studies are discussed; first the relations between the clouds and their energy sources in the subcloud layer and second, the interaction between the clouds and their environment in the cloud layer. Under the first heading, the various originating impulses for cumulus formation are mentionitd. and how the character of this impulse affects the spacing, scale and temperature structure of the clouds. The possible origins of trade cumuli are considered.

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Publication Date
Thu Dec 15 2022
Journal Name
Al-academy
The functional diversity of the directorial vision in the political theater cinema as a model
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It is very necessary for the political theater to be within the space of every theatrical performance, so that the theater carries the diverse and enlightened values and cultures of this world. political theatre. In the first chapter, the researcher dealt with (the methodological framework), which includes the research problem identified by the researcher with the following question (the functional diversity of the directorial vision in the political theater)
Importance, purpose, limits and seal by defining terminology.
In the second chapter, the researcher dealt with the theoretical framework on two topics, the first (transformations of directorial vision in theatrical performance) and the second topic (aesthetic experiences i

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Publication Date
Fri Sep 15 2023
Journal Name
Journal Of Water Resources And Geosciences
Evaluation of Water and Wheat Productivity under Center Pivot Sprinkler Irrigation in Desert Soils/Holly Karbala Governorate
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Two field experimسents were conducted in one of the fields of the Agriculture Division of Ain Al-Tamr /Holy Karbala Governorate at two sites of different textures during the agricultural season 2020/2021. The first site has sandy loam texture (gypsum soils). The second site has loamy sand texture (calcareous soils). The factors of the study included: The first factor included two types of soil, gypsum and calcareous soil. The second factor is the tillage systems (no-tillage, spring spike harrows, disc harrows, and mold board plow). The experiment was designed in the two study sites according to the RCBD with three replications. The Valley type center pivot irrigation system was evaluated before planting, three speeds, 30, 50 and 100% of th

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Publication Date
Fri Feb 08 2019
Journal Name
Journal Of The College Of Education For Women
A Unit Plan Based Upon The MI Theory: A theoretical study with an application Inside The Classroom
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This research basically gives an introduction about the multiple intelligence
theory and its implication into the classroom. It presents a unit plan based upon the
MI theory followed by a report which explains the application of the plan by the
researcher on the first class student of computer department in college of sciences/
University of Al-Mustansiryia and the teacher's and the students' reaction to it.
The research starts with a short introduction about the MI theory is a great
theory that could help students to learn better in a relaxed learning situation. It is
presented by Howard Gardener first when he published his book "Frames of
Minds" in 1983 in which he describes how the brain has multiple intelligen

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Publication Date
Wed Jun 24 2020
Journal Name
Bulletin Of The Iraq Natural History Museum (p-issn: 1017-8678 , E-issn: 2311-9799)
A STUDY OF PHYSICAL AND ANATOMICAL CHARACTERISTICS OF THE HEAVY METAL ACCUMULATION OF JUNCUS RIGIDUS DESFONTAINES, 1798 (FAMILY, JUNCACEAE) IN BASRAH PROVINCE, SOUTHEREN OF IRAQ
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This study was carried out to determine the heavy metal accumulation of Juncus rigidus Desfontaines, 1798 from three different regions of the Basrah Province in Southern of Iraq. Specifically, the concentrations of lead, nickel, and cadmium were determined in the roots, culms and leaves of the plant. The results indicated that the highest accumulation of the heavy metal was recorded in lead (Pb) 12.50± 3.58 mg kg-1and then in nickel (< 0.30). The lowest value was recorded for cadmium (< 0.05). As well, lead concentrations in J. rigidus varied in different locations and parts of the plant from undetectable in control to 12.66, 19.33, and 9.80 mg kg-1 in leaves, culm, and roots respective

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Publication Date
Wed Jun 14 2023
Journal Name
Al-academy
The mechanisms of the actor's work between performance and directing style in the contemporary theater show (Western) as a model
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The actor has mechanisms that were applied in the performance، as it formed a style in the theatrical form (weird)، and the researcher deliberately studied these mechanisms and divided them into four chapters.

The researcher divided it into two sections، the first is the actor's performance requirements، and the second is the boring performance methods in the directors' theater، and then the researcher concluded the second chapter with the most important indicators.

As for the third chapter، the researcher determined the society of his research and the method of selecting the sample (strange) and analyzing the sample and concluded with the most important results of the sample analysis.

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