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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 Aug 22 2025
Journal Name
Frontiers In Political Science
The role of identity in a multilevel interdependence in international relations: exploring popular understandings of international politics
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This study investigates the role of identity as a critical factor in mediating the relationship between local and regional politics within the broader context of international relations (IR). While identity is frequently acknowledged as a catalyst for political instability and conflict, its function in fostering interdependence across political levels remains underexplored, particularly through empirical research. To address this gap, the study adopts a quantitative methodology, drawing on theories of identity politics and interdependence. A structured survey was administered to assess public perceptions of identity's influence on international engagement and its bridging role between domestic and regional political dynamics. The fi

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Publication Date
Fri Jan 01 2021
Journal Name
Journal Of Accounting And Financial Studies ( Jafs )
The effect of marketing vigilance in attracting deposits: Applied research in a sample of private commercial bank
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The aim of the research is to demonstrate the impact of the dimensions of the marketing vigilance represented by (environmental scanning, diagnostic capacity, validity and decision-making) and to attract deposits represented by (customer relationship management strategy, distribution strategy (location), promotion strategy), as the research was applied in each of Banks (Assyria International, Iraqi Middle East Investment, Business Bay, Iraqi Investment, Babel, Al Mansour Investment), and the questionnaire was adopted as a main tool for collecting data and information from a sample of (110) who are in the position (department manager, department manager, assistant Section Director, Division Officer, Unit Officer), and the statistical prog

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Publication Date
Wed Mar 29 2017
Journal Name
Iraqi Journal Of Pharmaceutical Sciences ( P-issn 1683 - 3597 E-issn 2521 - 3512)
The Prevalence of Microorganisms in H1N1 Patients Compared to Seasonal Influenza in a Sample of Iraqi Patients
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This study provides valuable information on secondary microbial infections in H1N1 patients compared to Seasonal Influenza in Iraqi Patients. Nasopharynx  swabs were collected from  (12 ) patients  infected with Seasonal influenza (11  from Baghdad  and 1 Patient from south of Iraq) ,and ( 22 ) samples from patients with 2009 H1N1 ( 20 from Baghdad and  2 from  south of Iraq). The results show that the patients infected with 2009 H1N1 Virus were younger than healthy subjects and those infected with seasonal influenza. And the difference reached to the level of significance     (p< 0.01) compared with healthy subjects.Two cases infected with 2009 H1N1 virus (9.1%) were fro

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Publication Date
Tue Dec 01 2015
Journal Name
Journal Of Economics And Administrative Sciences
Factors Influencing the Establishment of Investment Portfolios ((Analytical Research in a number of Private Banks in Baghdad))
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       The investment portfolio of financial instruments & banking relatively new in the banking sector & the world of investment &capital markets in spite of its importance & its advantages in terms of the nature of the diversity of investment instruments as well as reduce the risk of investment & its contribution to the revitalization of the banks & the financial market , economic,  &characterized by developments accelerated under information & communications technology , as is the portfolio tool vehicle of investment tools that provide for people who want to invest & they can not manag

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Publication Date
Wed Dec 30 2020
Journal Name
Modern Sport
The effect of exercises according to the differentiated education method in developing agility and learning the collar skill of students in rhythmic gymnastics
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The second half of the last century witnessed a great scientific revolution that was able to bring about wide changes in various fields, including the field of physical education, which plays a fundamental role in the process of change for the better, and which knocked all the doors of modern science in various aspects and from this perspective we see that students have different capabilities And interests and motives, which require providing a differentiated education, and this depends on the necessity of knowing each student and on the school’s ability to know appropriate strategies for teaching each student so there is no single way to teach so the research problem comes in experimenting with an educational method that works on

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Publication Date
Sun Feb 28 2021
Journal Name
Journal Of Economics And Administrative Sciences
Strategic Information Systems and their effects on the Developing of Intellectual Capital in the Electricity Distribution Company in the Hashemite Kingdom of Jordan
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This research aims to study the impact of strategic information systems on the development of intellectual capital in the Public Shareholding Electricity Distribution Company in the Hashemite Kingdom of Jordan. To achieve the objectives of the study, a questionnaire was developed for the purpose of data collection, as the number of valid questionnaires for analysis was about (135), and SPSS and AMOS 0.26 software was used to analyze the collected data. The study found out that the respondents' perceptions of the level of importance of strategic information systems and the level of importance of intellectual capital were high, and that the relational capital has ranked as first, followed by structural capital, and h

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Publication Date
Sun Jul 01 2018
Journal Name
القانون المقارن
The mechanism for selecting the President of the Republic and his constitutional powers under the Constitution of the Republic of Iraq
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The mechanism for selecting the President of the Republic and his constitutional powers under the Constitution of the Republic of Iraq

Publication Date
Mon May 17 2021
Journal Name
Indian Journal Of Forensic Medicine &amp; Toxicology
The Effect of Exercises with a Proposed Device to Improving Some Bio-Kinematic Variables and the Performance of the Arab Round off Skill on Floor Movement Mat Device of the Artistic Gymnastics for Women
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The importance of the research lies in preparing exercises using a proposed device to learn the skill of thehuman wheel on a machine rug of ground movements of the artistic gymnastics. As for the research problem:Through the presence of the two researchers as teachers and observers of this sport in the gymnastics hall,they noticed that there is difficulty in the students’ performance of the skill of the round off on the machineof the mat of ground movements, according to the researchers’ opinion, the reason for this is that skillsare taught with the limited availability of assistive devices, as well as the lack of use of these devices inexercises according to biomechanical variables, although they facilitate the learning process

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Publication Date
Thu Dec 13 2018
Journal Name
Al-adab Journal
A Victim of "Love": A Study of Beatrice’s Character in "Rappaccini's Daughter" By Nathanial Hawthorne
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Nathaniel Hawthorne (1804-1864) has been widely known for his special interest in the female characters. In many of his novels, he narrates the conditions, values, and the institutions that surround and control the life of women, leading them to be victims. In “Rappaccini’s Daughter” (1844), the heroine, Beatrice is created to be victimized by her loved ones (her father and lover). This paper focuses on the term “victim,” it shows its aspects through the development of Beatrice’s character. The paper also studies a female character in the male-dominated society, to show the cruelty done to her, and how she is considered to be a second rate person, who is unable to live normally, or at least to save herself from dea

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Publication Date
Mon Mar 13 2017
Journal Name
Journal Of Baghdad College Of Dentistry
The Value of Ultrasonography in The Diagnosis and Evaluation of Early Therapeutic Response of Cervical Tuberculous Lymphadenitis
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ABSTRACT Background: Tuberculosis is a worldwide infectious disease in spite of advancement in health care system. Tuberculous lymphadenitis is the most prevalent form of extra pulmonary tuberculosis with predilection of cervical lymph nodes. Objectives: To evaluate the reliability of grey scale ultrasonography together with color Doppler in the diagnosis of cervical tuberculous lymph adenitis and evaluation of early therapeutic response. Subjects and methods:From July 2015 to May 2016 in Al-Karama teaching hospital /Kut city- Wasit-Iraq, 25 patients (14 males and 11 females) with ages range from (6-50) years. Ultrasonography examination was done for all patients and grey scale criteria (distribution, size, shape, echogenicity, echogenic hi

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