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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 Jun 30 2017
Journal Name
Journal Of Madenat Al-elem University College
Study the toxic effect of the herbicide Gold topik (80EC) on survival and behavior of mosquito fish (Gambusia holbrooki Girard 1859)
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Publication Date
Tue Dec 30 2025
Journal Name
Webology
Is the Stealth Marketing an Element of Promotion Mix? A Review of the Techniques
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Stealth marketing is considered as one of the contemporary issues that researchers have begun to explore as a current understanding. It is the marketing approach used by organizations to promote their products and services to the public in implicit and indirect manner. In this article, the concept of stealth marketing will be discussed throw its advantages and disadvantages. In addition, the different techniques of stealth marketing have been discussed including: viral marketing, celebrity marketing, brand pushers, bait-and-tease marketing, video games marketing, and marketing in music. Furthermore, a new technique of marketing entitled “Marketing through social responsibility” has been added and discussed according to the themes in the

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Publication Date
Mon Feb 01 2016
Journal Name
Al-academy
Building the foundations of a formal system of the laptop table: حنان غازي صالح
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The study of the laptop computer table is one of the important studies at the present time due to the importance of electronic computers that are used in work sites and homes for very long hours, so one of the most important basics of caring for the comfort of the user lies in the design of the laptop table in different shapes and sizes and multiple functions in addition to calculating the measurements of the human body and the extent Its compatibility with the design and measurements of laptop computer tables by taking into account the calculations and measurements of the dimensions of the user's body of all ages and their consistency and use with the general measurements of the tables and the importance of research comes through the es

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Publication Date
Mon May 11 2020
Journal Name
Journal Of Arts, Literature, Humanities And Social Sciences
The Kite Runner; A Journey of Growth
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Publication Date
Thu Jan 01 2015
Journal Name
Algebra Letters
THE GRAPH OF A COMMUTATIVE KU-ALGEBRA
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In This paper, we introduce the associated graphs of commutative KU-algebra. Firstly, we define the KU-graph which is determined by all the elements of commutative KU-algebra as vertices. Secondly, the graph of equivalence classes of commutative KU-algebra is studied and several examples are presented. Also, by using the definition of graph folding, we prove that the graph of equivalence classes and the graph folding of commutative KU-algebra are the same, where the graph is complete bipartite graph.

Publication Date
Tue Oct 01 2024
Journal Name
Computational And Theoretical Chemistry
The curious case of S4N4 − A reinvestigation
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Publication Date
Wed Jan 01 2014
Journal Name
Phd Thesis
Development of fore and hind limbs bone of guinea pig (Cavia Cutleri) during pre and postnatal period
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APFS Mohammed, 2014

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Publication Date
Tue Feb 05 2019
Journal Name
Journal Of The College Of Education For Women
Shortcomings mentioned by the Torah about the prophet Lot in the prophecies and the respond of Quran
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Praise be to Allah , and peace and blessings of God sent mercy to the worlds Muhammad
Amin and his family and his friends and followers to the Day of Judgement .
Savants Jews worked to distort the Torah calamity on the Prophet Moses ( peace be upon
him ) to achieve their goals and objectives , which are decorating sin to their followers , and
spreading corruption on earth, through the charge prophets Bmvassad , morality, as the
example and the example that emulate the human in the book of the Lord of the worlds and
their Prophet Lot, described the weak, and cheese, and lack of modesty, and disobedience ,
drinking alcohol , and his failure to raise his two daughters , Jews are corrupt in the ground .
Koran , which

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Publication Date
Mon Jan 01 2018
Journal Name
Al–bahith Al–a'alami
The Interactive Relationship between the Formation Elements and their Implications in the Structure of the Television Image
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The image of television dominates the cognitive and artistic motivations. It is the formulation of ideas and visions along with its documentary ability. It is the main element in television work as it is a story that is narrated in pictures. Therefore, attention to image building is a major point of gravity in the work structure as a whole. On the image is the element carrying all aesthetic and expressive values of news and information directly to the hints that work to stimulate and stir the imagination of the recipient to evoke mental images added to the visual images to deepen the meanings.
All visual arts carry elements and components that follow in a particular pattern to give special meanings and specific connotations. However,

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Publication Date
Tue Sep 15 2020
Journal Name
Al-academy
The Constant and the Variable in the Aesthetic Image of the Theatrical Direction: حازم عبد المجيد إسماعيل
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The theatre is one of the main pillars of the human aesthetic thinking as it contains logical explanations for the public human life aspects outside time and environment. When we find that the directive philosophical thinking moving away from the stylistic constants and the virtual laws in taboos that control the accomplishment in terms of the traditional shapes, the employment and the theatrical reception. Some directors moved in post-modernism concepts in a perceptive that liberates thought from its natural context in thinking into an innovative perceptive. The aesthetic images are the basic premise in the prohibition of the philosophical thinking interpretation in order to move the directive thinking and this movement depends on the v

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