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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
Sun Jun 30 2019
Journal Name
Journal Of The College Of Education For Women
(Evaluation and Mobility) As Two self-Organizing Posts for University Students
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One of the important goals in the learning process is to be effective learning through the self-direction of the learner , because it has an impact on the effort of learners , it is better to be a learner responsible for learning and independent of the acquisition of knowledge ,

اذ اكدتكثيرAs many have confirmed منFrom الدراساتStudies والادبياتAnd literature انthat فشلالكثير The failure of many منFrom الطلبةStudents فيin a تنظيمgroup المعلوماتthe information ومعالجتهاAnd processed اثناءduring عمليةProcess تعلمهمLearn them لاNo يرجعReturns الىto me انخفاضdrop فيin a درجةDegree ذكائهمTheir intelligence اوor عدمNo

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Publication Date
Fri May 16 2014
Journal Name
International Journal Of Computer Applications
Lossless Image Compression based on Predictive Coding and Bit Plane Slicing
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Publication Date
Mon Feb 20 2017
Journal Name
Proceedings Of The 5th International Conference On Communications And Broadband Networking
Bit precision and Cyclic prefix effect on OFDM Power Consumption Estimation
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Thu Jan 01 2015
Journal Name
The International Journal Of Biotechnology,
LACTIC ACID AS SPACER BETWEEN POLY ACRYLIC ACID AND 4- AMINOANTIPYRINE
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Publication Date
Thu Jan 24 2019
Journal Name
Journal Of Al-qadisiyah For Computer Science And Mathematics
On strongly E-convex sets and strongly E-convex cone sets
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              -convex sets and -convex functions, which are considered as an important class of generalized convex sets and convex functions, have been introduced and studied by Youness [5] and other researchers. This class has recently extended, by Youness, to strongly -convex sets and strongly -convex functions. In these generalized classes, the definitions of the classical convex sets and convex functions are relaxed and introduced with respect to a mapping . In this paper, new properties of strongly -convex sets are presented. We define strongly -convex hull, strongly -convex cone, and strongly -convex cone hull and we proof some of their properties.  Some examples to illustrate the aforementioned concepts and to cl

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Publication Date
Wed Apr 01 2009
Journal Name
6th.engineering Conference/college Of Eng. /university Of Baghdad
Comparison between analytical solution and experimental results for reinforced loose sand
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Presents here in the results of comparison between the theoretical equation stated by Huang and Menq and laboratory model tests used to study the bearing capacity of square footing on geogrid-reinforced loose sand by performing model tests. The effects of several parameters were studied in order to study the general behavior of improving the soil by using the geogrid. These parameters include depth of first layer of reinforcement, vertical spacing of reinforcement layers, number of reinforcement layers and types of reinforcement layers The results show that the theoretical equation can be used to estimate the bearing capacity of loose sand.

Publication Date
Fri Oct 03 2025
Journal Name
Mesopotamian Journal Of Computer Science
Enhanced TEA Algorithm Performance using Affine Transformation and Chaotic Arnold Map
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In digital images, protecting sensitive visual information against unauthorized access is considered a critical issue; robust encryption methods are the best solution to preserve such information. This paper introduces a model designed to enhance the performance of the Tiny Encryption Algorithm (TEA) in encrypting images. Two approaches have been suggested for the image cipher process as a preprocessing step before applying the Tiny Encryption Algorithm (TEA). The step mentioned earlier aims to de-correlate and weaken adjacent pixel values as a preparation process before the encryption process. The first approach suggests an Affine transformation for image encryption at two layers, utilizing two different key sets for each layer. Th

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Publication Date
Sun Dec 01 2013
Journal Name
Journal Of Accounting And Financial Studies ( Jafs )
Lean accounting and its rolls for calculated costs on value stream
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At the last two decades , The environment has witnessed tremendous changes in many fields with the huge competition , various technological development and customer satisfaction , that are reflected in economic units a doption for lean production system .                 

      Lean Accounting that has appeared as aresponse for changes occurred of economic units adoption for lean accounting system instead of wide production system : through it management of economic units has been changed from management by top departments into management by value flows : has provide new method for accounting costs according to value flow

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Publication Date
Wed Mar 16 2022
Journal Name
Journal Of Educational And Psychological Researches
Administrative Empowerment and Its Relationship to Remote Supervision at Public Schools
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The study aims to identify the extent of the availability of administrative empowerment and the implementation of remote supervision in relation to two variables with respect to the employees of the Saudi Ministry of Education. The study included (456) male and female supervisors. The questionnaire has been administrated to collected data related to the research aims. The results indicated that both the extent of the availability of administrative empowerment and the implementation of remote supervision is of an average degree. There is a significant correlation relationship (p<0.05) between administrative empowerment and remote supervision of the educational supervisors of the Saudi Ministry of Education. The research recommends that

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Publication Date
Sat Mar 01 2025
Journal Name
Iranian Journal Of Nursing And Midwifery Research
Girls’ Self-Esteem and its Association with Self-Stigma toward Obesity
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Abstract<sec> <title>Background:

Obesity among girls can lead to physical, psychological, or social problems. Enhancing self-esteem and reducing self-stigma toward obesity can play a crucial role in girls’ health. This study aims to assess girls’ self-esteem and its association with self-stigma toward obesity.

Materials and Methods:

A descriptive cross-sectional design was used to meet the study’s objective. A convenience sampling method was used to gather the sample from 24 middle and high schools in five cities across Iraq from (January

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