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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 Oct 30 2020
Journal Name
Journal Of Economics And Administrative Sciences
The effect of applying total quality management on the competitiveness from the point of view of the front-rows employees for customer service (An analytical study of Palestinian local banks)
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The study aimed to identify the effect of Total Quality Management on enhancing competitiveness through the opinions of employees of the front- rows of customer service in local Palestinian banks, the researcher adopted an analytical descriptive method through developing a special questionnaire to accomplish the study’s objectives and answer its questions. The study involved all the Palestinian local banks, with their scattered branches in West Bank. The study sample consisted of 3470 executive employees for banking services out of 4753 employees, in the rate of 73%, and the study sample reached (485) employees who were randomly selected working in the front -rows to provide services in the local Palestinian banks during the ye

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Publication Date
Mon May 01 2017
Journal Name
Ieee International Electrical Machines & Drives Conference Ieee (iemdc2017), Miami, Usa
The effect of power converter on the design of a Linear Alternator for use with a Joule Cycle-Free Piston Engine
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Publication Date
Sat Dec 01 2012
Journal Name
Journal Of Economics And Administrative Sciences
The effect of transformational leadership in the employee’s motivation in the organizations
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The transformational leaderships in all organizations  consider Motivations policies which is one of the main and basic policies adapted by the successful leaderships in all organizations, in order to be able to achieve essential goals, such as enhancing loyalty of employees towards their organizations and also developing and empowering their capacities and abilities in work, leading to development and increasing productivity and reducing production costs to the minimum, then reaching immense profits and benefits, in addition to development of excellence in the market of competition.

The research was performed in the (General Company of Leather Industries/ in Baghdad ,in alkarada) the study reached

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Publication Date
Wed Jan 07 2026
Journal Name
Journal Of Physical Education
The effect of special exercises using a designer device and added relative weights to develop some of the physical abilities of volleyball players
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Publication Date
Tue Jun 21 2022
Journal Name
Journal Of Planner And Development
Use of GIS to study spatial analysis of the migration of nineveh governorate residents for the period 2014-2017
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The Migration is one of the important dynamic population movement phenomena in population studies because of its great impact in changing many demographic characteristics between the region of origin and arrival. And the multiplicity of forms and types according to the different reasons for it and the motives that prompted the population to move, as well as the currents and their size are also different according to the different causes, and here there are many types of migration, and many of them have been studied at the local and regional levels, and as long as the population is in a continuous dynamic movement, other types of migration are generated. (Al Douri, 2015, 230)          &nbs

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Publication Date
Fri Dec 01 2017
Journal Name
2017 Ieee 56th Annual Conference On Decision And Control (cdc)
Hierarchical non-singular terminal sliding mode controller for a single link flexible joint robot manipulator
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—This paper studies the control motion of a single link flexible joint robot by using a hierarchical non-singular terminal sliding mode controller (HNTSMC). In comparison to the conventional sliding mode controller (CSMC), the proposed algorithm (NTSMC) not only can conserve characteristics of the convention CSMC, such as easy implementation, guaranteed stability and good robustness against system uncertainties and external disturbances, but also can ensure a faster convergence rate of the systems states to zero in a finite time and singularity free. The flexible joint robot (FJR) is a two degree of freedom (2DOF) nonlinear and underactuated system. The system here is modeled as a fourth order system by using Lagrangian method. Based on t

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Publication Date
Wed Jan 01 2025
Journal Name
Biomaterials Science
Single-atom silver-borophene hybrid hydrogels for electrically stimulated wound healing: a multifunctional antibacterial platform
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Publication Date
Fri Feb 08 2019
Journal Name
Iraqi Journal Of Laser
Fusion Splicing for a Large Mode Area Photonic Crystal Fiber with Conventional Single Mode Fiber
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In this paper the experimentally obtained conditions for the fusion splicing with photonic crystal fibers (PCF) having large mode areas were reported. The physical mechanism of the splice loss and the microhole collapse property of photonic crystal fiber (PCF) were studied. By controlling the arc-power and the arc-time of a conventional electric arc fusion splicer (FSM-60S), the minimum loss of splicing for fusion two conventional single mode fibers (SMF-28) was (0.00dB), which has similar mode field diameter. For splicing PCF (LMA-10) with a conventional single mode fiber (SMF-28), the loss was increased due to the mode field mismatch.

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Publication Date
Sat Dec 15 2018
Journal Name
Journal Of The College Of Education For Women
Camille Ben Ziad and his Place in the Arab-Islamic Heritage (Historical Study)
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In a quick reading of the character of Camille Ben Ziad al-Nekha al-Kufi al-Taabi, one of the most sincere companions of Imam Ali (peace be upon him), he enjoyed great status and status because he was one of the people of his people who lived alongside Imam Ali (peace be upon him) since his tribe migrated from Yemen to Kufa To this end, he became loyal during the reign of Imam Ali (peace be upon him), who is also a member of the delegation coming from Kufa to protest against the actions of the Wali of Kufa during the reign of Caliph Uthman ibn Affan. After the death of Caliph Uthman bin Affan, (Peace and blessings of Allaah be upon him) (Duaa kamil), one of the most famous and important supplications in Islamic history, and each one of u

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Publication Date
Wed Aug 15 2018
Journal Name
Al-khwarizmi Engineering Journal
Study the Dissociation Enthalpies for R134a Clathrate Hydrate in Binary and Ternary Systems
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In the present work the clathrate hydrate dissociation enthalpies of refrigerant R134a+ water system, and R134a + water + salt system were determined. The heat of dissociation of three types of aqueous salts solutions of NaCl, KBr and NaF at three concentrations (0.09, 0.17and 0.26) mol·kg−1 for each salt type, were enthalpy measured. The Clapeyron equation was used tocalculate heat of dissociation of experimental data for binary and ternary system.In order to find the effect of compressibility factor on heat dissociation enthalpy, the study was conducted by using equation of state proposed by Peng and Robinson Stryjek-Vera (PRSV). The obtained results of dissociation enthalpy for binary system were (143.8) kJ.mol-1

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