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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 Jan 01 2017
Journal Name
Transportation Research Procedia
The importance of intelligent transport systems in the preservation of the environment and reduction of harmful gases
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Publication Date
Tue Aug 15 2023
Journal Name
Al-academy
The aesthetics of the sculptural formulations of swords in the Al-Kafeel Museum of Treasures and Manuscripts
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The research included (the aesthetics of the sculptural formulations of swords in the Al-Kafeel Museum) four chapters. Al-Kafeel Museum.)
Within the time period: (1240 AH / (1824 and 1825) AD - 1312 AH / (1894 and 1895) AD). The second: the types of Islamic swords. The third chapter included (research procedures), and the analysis of samples from the sample (3) as a model according to the descriptive approach, and the fourth chapter dealt with (results, conclusions, recommendations, and proposals). As well as recommendations, proposals and sources.

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Publication Date
Wed Aug 01 2018
Journal Name
Journal Of Economics And Administrative Sciences
The impact of electronic audit in raising of the independence and professional efficiency of the internal auditor
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The research aims to shed light on the role of E-Audit in raising Independence and professional competence of the external auditor, the study has been applied on a sample of the branches of the Rafidain Bank n have been addressed research topic beside the theoretical, as put forward by the literature of accounting, audit and that the contents of the section first, either the practical side was required to test the hypotheses use form questionnaire, which was distributed to a sample of the external auditors and bankers research sample. He has applied for his part in the search for a standard of independence and professionalism of the external auditor and the factors influencing these standards, and the most import

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Crossref
Publication Date
Fri Sep 15 2023
Journal Name
Al-academy
The social imagination and its representations in the paintings of students of the Department of Art Education
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The aim of this research is to identify how to employ the social imagination and its representations in the paintings of the students of the Department of Art Education. Students of the Department of Art Education in the light of this tool, and the researcher reached a number of results, the most important of which are:
1. The indicator of the social imagination in the excitement of the artist and the recipient, because the representations are embodied in forms within the painting and close to reality.
2. An artistic sample of the representational imagination and the creative imagination was found to be more than the imaginary imagination.
3. Individual symptoms related to the term.
4. The representations of the socia

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Publication Date
Sun Feb 01 2015
Journal Name
Journal Of Economics And Administrative Sciences
An analytical study at the General Company for the manufacture of batteries
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    This study carry’s out the correlation and the effect of two main variables, these variables are Job Satisfaction included six sub: wages - salaries and justice and yield, working  conditions    and services, pattern of supervision and the relationship with the manger, Relationship with colleagues, the content of the work and the variety of tasks, development and  promotion  opportunities available  to  an individual,   and Organizational Performance included  two sub variables:  Efficiency, Effectiveness.  This research was conducted using a questioner as a main tool, This questioner was distributed randomly to a research community composed of

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Publication Date
Wed Feb 03 2016
Journal Name
Iraqi Journal Of Physics
Study the variation of synodic month for the moon through 2000-2100
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In this research study the synodic month for the moon and theirrelationship with the mean anomaly for the moon orbit and date A.Dand for long periods of time (100 years), we was design a computerprogram that calculates the period of synodic months, and thecoordinates of the moon at the moment of the new moon with highaccuracy. During the 100 year, there are 1236 period of synodicmonths.We found that the when New Moon occurs near perigee (meananomaly = 0°), the length of the synodic month at a minimum.Similarly, when New Moon occurs near apogee (mean anomaly =180°), the length of the synodic month reaches a maximum. Theshortest synodic month on 2053 /1/ 16 and lasted (29.27436) days.The longest synodic month began on 2008 /11/ 27 a

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Publication Date
Sun Feb 03 2019
Journal Name
Iraqi Journal Of Physics
Study the variation of synodic month for the moon through 2000-2100
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In this research study the synodic month for the moon and their
relationship with the mean anomaly for the moon orbit and date A.D
and for long periods of time (100 years), we was design a computer
program that calculates the period of synodic months, and the
coordinates of the moon at the moment of the new moon with high
accuracy. During the 100 year, there are 1236 period of synodic
months.
We found that the when New Moon occurs near perigee (mean
anomaly = 0°), the length of the synodic month at a minimum.
Similarly, when New Moon occurs near apogee (mean anomaly =
180°), the length of the synodic month reaches a maximum. The
shortest synodic month on 2053 /1/ 16 and lasted (29.27436) days.
The lo

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Publication Date
Fri Mar 01 2013
Journal Name
Journal Of Economics And Administrative Sciences
The effect of Analysis of internal environment in the quality of health care service survey study at AL_Elwiya Maternity Teaching Hospital
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he current research aims at showing the correlation and effect of the internal environment analysis in the quality of health service in AL_Elwiya Maternity Teaching Hospital, researcher depended on the integral method in the "analytical descriptive method" for the study of the relation between the main variables and the sub-variables throughout data collection required by the theme of this study, a case study" in tackling the data and information related to the financial aspects of the internal environment.

The problem of the study was manifested in the essential question, that is (is there internal struc

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Publication Date
Tue Sep 30 2014
Journal Name
Iraqi Journal Of Science
The Prevalence of Autoimmune Thyroiditis in A sample of Infertile Iraqi Women
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In the present study, the aim was made to identify the relationship between thyroid autoimmunity (TAI) and female infertility. The study was performed on 30 infertile women and 22 age-matched healthy fertile control age (33 ± 5 years). Overall, serum prolactin (PRL), thyroid stimulating hormone (TSH) assay is the key test for the diagnosis and management of hypo and hyperthyroidism. Anti-TPO Ab and anti-TG Ab were measured. The mean ± SE of serum PRL (31.080 ± 3.06) ng/ml was significantly (P<0.05) higher in infertile group compared with control (16.191±1.36) ng/ml. Serum TSH was significantly (P<0.05) higher in infertile group (5.689 ± 1.12) µIU/ml compared to control group (2.282 ± 0.18) µIU/ml. The prevalence of positive

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Publication Date
Fri Mar 12 2021
Journal Name
Alustath Journal For Human And Social Sciences
A Cognitive Stylistic Analysis of Characterization in Golding’s Lord of the Flies
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Characterization is commonly known in stylistics to be the cognitive process in the readers' minds when comprehending a fictional character in a literary work .In one approach, it is assumed that characters are the outcome of the interaction between the words in the text on the one hand and the contents of our heads on the other. This paper is an attempt to understand how characterization is achieved by applying Culpeper’s (2001) model which seems to be to present a method of analysis that is more objective and more systematic in analyzing characters. Two characters are selected for discussion; Ralph and Jack from Golding’s (1954) Lord of the Flies. The novel talks about the corruption of human beings and the capacity of evil th

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