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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 2020
Journal Name
International Journal Of Innovation, Creativity And Change
The role of the forensic accountant in achieving the integration of accounting and legal performance
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Publication Date
Sat Feb 09 2019
Journal Name
Journal Of The College Of Education For Women
The Spatial Poetics and the "Murder of the Real"in Paul Auster's City of Glass*
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Paul Auster's City of Glass is here singled out as representative of the writer's The New
York Trilogy. All throughout his novelistic career, Auster has been working on a pseudothesis
that adheres to a certain aesthetic of disappearance. The study engages this Austerian
aesthetic apropos of certain theoretical stretches such as the Emersonian "Not Me", the
Thoreauvian "interval" or "nowhere", the Deleuzian "nomadic trajectory", the Derridian
"grammè" or "specter", and the Baudrillardian "disappearance". The city of the novel's titling
is here seen as the trope of all that which has already disappeared, and hence it is seen as the
space (mise en scène) where the perfect crime of the murder of the real is to be thoro

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Publication Date
Tue Mar 01 2011
Journal Name
Journal Of Economics And Administrative Sciences
Measurement and analysis of the production function of the transport sector in the Iraqi economy
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Transportation Sector classified as one of the services sectors which is without the production activities cannot be complete its rule. Is act asmoving actions which operate at production and non production goals for the organization and individuals insides the country and with others, that is why this sector act as one of the main which is occupied an important status on the way the economic activities and on the level of the economic institutions the transportation work on transforming all the commodities and products from productions locations to consumption location then its effect the productivity process and create the location utility and on the level of economic it considered as one of the economic supportive structure an

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Publication Date
Sun Nov 01 2015
Journal Name
Journal Of Engineering
A Spike Neural Controller for Traffic Load Parameter with Priority-Based Rate in Wireless Multimedia Sensor Networks
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Wireless Multimedia Sensor Networks (WMSNs) are a type of sensor network that contains sensor nodes equipped with cameras, microphones; therefore the WMSNS are able to   produce multimedia data such as video and audio streams, still images, and scalar data from the surrounding environment. Most multimedia applications typically produce huge volumes of data, this leads to congestion. To address this challenge, This paper proposes Modify Spike Neural Network control for Traffic Load Parameter with Exponential Weight of Priority Based Rate Control algorithm (MSNTLP with EWBPRC). The Modify Spike Neural Network controller (MSNC) can calculate the appropriate traffi

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Publication Date
Fri Dec 01 2023
Journal Name
Iop Conference Series: Earth And Environmental Science
The Effect of Power Sources in the Agricultural Tractor and the Developed Sprayer System on the Performance of the Electrical and Mechanical Sprayer System and some Performance Indicators of the Engine
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Abstract<p>An experiment was conducted to study the effect of the sprayer type according to the source of power and the size of the spray nozzle concerning the quality of the spray produced and fuel consumption.Two types of sprayers were used: a conventional boom sprayer (S1) and a modified (electrified) boom sprayer (S2), along with three sizes of the XR TeeJet 110 spray nozzle (N). The following technical performance indicators were examined: Density of coverage (drops/cm2) using ImageJ software, a 600dpi business card scanner, specifically the ScanShell 800N by CSSN, Inc, and water-sensitive paper (WSP), rate of spray nozzles discharge (ml/min), and fuel consumption (liters/hectare) using a c</p> ... Show More
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Publication Date
Mon Oct 01 2018
Journal Name
Journal Of Economics And Administrative Sciences
The effect of deficiencies in the standards and tools used for the management of the banking system in the emergence of the financial crisis by focusing on the Basel 1and 2
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The banking industry, as a result of the great challenges it faced, required continuous development of the principles of management, control and mechanisms used. The Basel Committee on Banking Supervision has played a leading role in legalizing many of these developments and has been able to contribute significantly to establishing a common framework for banking supervision, The central role in the various countries of the world is based on coordination between the various regulatory authorities and thinking about finding mechanisms to confront the risks faced by banks, recognizing the importance of the banking sector in the stability of domestic and international banking systems or the danger of this sector in the emergence of F

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Publication Date
Mon Sep 30 2019
Journal Name
College Of Islamic Sciences
Loqmania commandments in the Koran And its impact in the refinement of the doctrine and morals emerging
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Luqman's story stated that human instinct, if I was brought up properly, reaches wisdom and inflicts the right to everything. It is to go to worship God and adhere to the satisfaction of morals and high morals that are ordered to meet among human beings in this life, because this worship educates in the soul the most beautiful morals needed by human beings of honesty, honesty and modesty, and the work of good and virtues, and distancing the soul from evil and vices.

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Publication Date
Tue Dec 01 2020
Journal Name
Journal Of Economics And Administrative Sciences
The effect of liquidity on the profitability and value of banks listed on Iraq stock market (An analytical study)
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  The purpose of the study is to analyze the extent of the impact of liquidity as an independent variable on profitability as an intermediate variable and the value of banks listed in the Iraq Stock Exchange as a dependent variable, as the research problem is summarized by the fact that most banks focus on profitability as a phased goal without focusing on maximizing its value as a strategic goal by enhancing the wealth of owners and shareholders. On the long term, the research community is represented by the banks listed on the Iraq Stock Exchange, while the research sample was deliberately chosen, which included three private banks such as Baghdad Commercial Bank, the Iraqi Commercial Bank and the Iraqi Investment Bank, an

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Publication Date
Sun Jan 01 2023
Journal Name
Technologies And Materials For Renewable Energy, Environment And Sustainability: Tmrees22fr
Preparation and study the partial substitution of aluminum with copper on some physical properties of the compound TlSr2Ca2Cu3O8+δ
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Publication Date
Wed Mar 30 2022
Journal Name
College Of Islamic Sciences
"Explanation of the Fundamentals for Al-Bazdawi" Study and Investigation (From the beginning of Prohibition Chapter to its End)
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This research addresses: Sharh Usul Al-Bazdawi "Explanation of the Fundamentals for Al-Bazdawi", by studying and investigating, from the beginning of prohibition chapter to its end. The researcher conducted a study about this book stating its significance and introducing the compiler and the commentator. The researcher as well mentioned that the prohibition has a special formula and requires repetition, and he went on explaining that prohibition according to Hanafis does not require absolute corruption of the prohibited matter unless based on an evidence, and that what is condemned as wrong act for itself is considered void and what is condemned as wrong act for external reasons is considered corrupt accor

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