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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
Tue Mar 01 2016
Journal Name
Al-academy
Harmonization formative in the design of interior spaces Hall of discussions in the design department (a model): بدريا محمد حسن فرج
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Can not reach a comprehensive concept for interior design through the use of Harmonization term according transformations experienced by the terms of the variables associated with the backlog of cultures that characterize concepts according to the nature of the users of the spaces in the design output, which necessitates the meaning of the combination of knowledge, art, science, such as the type of perceptions design the Harmonization cognitive science with art to create products of the use of design configurations that help the designer to put such a product within the reality and like the fact that reliable, as well as the rational knowledge tend somehow to the objective specifically in facilitating the substance subject to perceptible

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Publication Date
Thu Mar 20 2025
Journal Name
Tikrit Journal Of Engineering Sciences
Effect of Different Compressor Speeds on the Energy and Exergy of an Automobile Air-Conditioner Using R134a in the Absence and Presence of a Liquid-Suction Heat Exchanger
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Refrigerant R134a has been widely utilized in automotive air conditioning systems (AACSs); R134a has a high global warming potential (GWP) of 1430 despite having zero ozone depletion potential (ODP). Coming refrigeration systems must include refrigerants with low GWP and zero ODP. The aim of this experimental study is to evaluate the thermal performance of an (AAC) with different values of compressor speeds, i.e., (1000, 1700, and 2400 rpm) and two thermal loads, i.e., (500 and 1000 Watt) with the absence and presence of liquid suction heat exchanger (LSHX) using R134a. The results showed that adding LSHX enhanced the COP cycle by 7.18%, 10.7%, and 3.09% for the first, second, and third speed, respectively, at 500 Watt, while the en

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Publication Date
Fri Mar 01 2024
Journal Name
Results In Engineering
Experimental and analytical study of the energy and exergy performance for different evaporative pads in hot and dry climate
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In this work, effects of using different evaporative cooling pads (ECPs) on the energetic and exergetic efficiency of a direct evaporative air cooler (DEAC) have been theoretically and experimentally investigated. Three types of ECPs were used, i.e., honeycomb cellulose cooler pad (HCCP), shading-cloth cooler pad (SCCP), and aspen wood wool cooler pad (AWWCP). For SCCP and AWWCP, a 3-cm pad thickness was used, while for the HCCP, three different values of pad thickness were used, i.e., 3, 5, and 7 cm. Tests were carried out using air velocities of 8, 14, and 19 m/s, measured at the DEAC outlet. Engineering equation solver (EES) used for performing the required calculations of the various parameters affecting the thermal performance of the D

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Publication Date
Sun Dec 16 2018
Journal Name
Al-academy
The Eloquence of the Sound in the Production of Mental Image in the Feature Film
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Publication Date
Sun Dec 16 2018
Journal Name
Al-academy
The Eloquence of the Sound in the Production of Mental Image in the Feature Film
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The ideas and information obtained by the viewer in the cinema have always been the source of the visual image, but that doesn’t negate the fact that the mental image can produce a lot of the information and ideas in the cinematic art and the most important means to achieve this mental image in the film is the eloquent cinematic sound. This research is conducted to show this important and effective contribution of the sound in the production of the mental image. Hence the importance of this research is in that it addresses an important issue which is the eloquent performance of the sound and its role in the production of the mental image inside the space of the feature film. This research concerns those working the field of cinema and

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Publication Date
Mon Mar 20 2023
Journal Name
Liquid Crystals
Synthesis and study the mesomorphic behaviour of some new 1,3,4-thiadiazoline derivatives
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Investigation of mesomorphic properties of new 1,3,4-thiadiazolines (which are synthesised via many steps in Scheme 1) was carried out in this study. These compounds are designed to have a heterocyclic unit, a carboxylate linkage group and a polar ether chain at the end of the molecule adjacent to the benzene ring, which enhance the dipolar interactions forces (varied from one to eight carbons) to investigate the association properties of their phases. The structure of the target compounds and the intermediates were confirmed by 1H NMR, 13C NMR, mass and FTIR spectral techniques. Polarised microscopic studies revealed that all the compounds in the series exhibited enantiotropic liquid crystalline properties. This was further confirmed using

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Publication Date
Wed Dec 30 2015
Journal Name
College Of Islamic Sciences
Indication of body overtones and movements at The Holy Quran (Descriptive study)
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That communication between people is not only through speech but includes other images of the most important body inspiration. And that the Koran worked on the diversity of ways in which the meanings of the hearer and did not stop at the limit of speech, but included situations where the use of body inspiration and indicate its importance in communication. However, signals and organ movements play a major role in the process of communication between people. Facial and hands movements play an important role in the communication process as they are a tool for communicating ideas to others.

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Publication Date
Mon Jan 01 2018
Journal Name
Aip Conference Proceedings
The study of behavior titanium pure commercially coated with hydroxyapatite and zirconia
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Publication Date
Wed Nov 03 2021
Journal Name
International Journal Of Energy Research
Simulation and experimentation study on the performance of metal hydride storage vessels
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This paper details the process of designing, analysing, manufacturing, and testing an integrated solid-state hydrogen storage system. Analysis is performed to optimise flow distribution and pressure drop through the channels, and experimental investigations compare the effects of profile shape on the overall power output from the fuel cell. The storing of hydrogen is given much attention in the selection of a storage medium, and the effect of a cooling system to reduce the recharging time of the hydrogen storage vessel. The PTFE seal performed excellently, holding pressure over 60 bar, despite requiring changing each time the cell is opened. The assembly of the vessel was simple and straightforward, and there was no indication of pressure

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Publication Date
Wed Nov 03 2021
Journal Name
International Journal Of Energy Research
Simulation and experimentation study on the performance of metal hydride storage vessels
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