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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 Jun 02 2019
Journal Name
Journal Of The College Of Languages (jcl)
The vision of Hebrew writers and critics of the future of the Jews in their writings at the end of the 19th century and the beginning of the twentieth c: דעותיהם של הסופרים והמבקרים העבריים על עתידם של היהודים לפי כתבותיהם בשלהי המאה ה-19 ובתחילת המאה ה-20
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It is very known  how great is the  role of the Jewish writers in the system of the Zionist movement. The movement relied on writers and writers to carry out their programs, especially those pertaining to the creation of a "national homeland" for Jews. Most Jewish writers sang of  Palestine even though they were not born there.

    On such a  basis, we have followed closely the writings of writers, critics and others by the end of the nineteenth century and the beginning of the twentieth century. We found that these writings are based on one common question: What is the fate of the Jewish people?

    Most of these writings were accompanied by Theodor Herzl's proj

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Publication Date
Tue Mar 01 2016
Journal Name
Al-academy
The effectiveness of visual intelligence strategy in the collection of students in the Department of Art Education in the perspective material: أسامة حسن عبد علي الصفار
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Select the researcher discussed problem of asking the following : Do you use visual intelligence strategy effective in the collection of students in the Department of Art Education in the foreseeable material ? The research aims to " measure the effectiveness of the strategy in the collection of visual intelligence students in the Department of Art Education in the foreseeable material ". To verify the objective of this research was identify hypotheses zero to measure the level of achievement in the foreseeable material second grade students in the Department of Art Education - Faculty of Fine Arts . The population of the research students in the Department of Art Education / Faculty of Fine Arts at the University of Baghdad who are stud

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Publication Date
Sun Jan 01 2023
Journal Name
Iop Conference Series: Earth And Environmental Science
The new industrial cities and resources sustainability - case study: industrial zone in Ramady city
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Abstract<p>The modern industrial projects and complexes that adopt ecological systems, and renewable, clean and environmentally friendly energy, not only contribute to the development of an environmentally friendly production method but can achieve long-term economic and industrial development by preserving environmental resources. The ecological industrial systems and modern industrial technologies are the ideal solutions to rationalize excessive use and preserve the elements of the environment and natural resources, the most important of which is the existence of several methods and programs for the development of industrial sites, and there is important to adopt mechanisms and programs to sol</p> ... Show More
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Publication Date
Sun Feb 03 2019
Journal Name
Journal Of The College Of Education For Women
The Archaeological Surveying in Wadi Al – yabis in Jordan (( Athnoarchology study ))
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Wadi AL – yabis situated to the north jorden , its extended from Aglon
mountain to the jorden river , the surveying of this valley about 186 KM , and the
highest point in it about 1200 m upon the sea level , the lower point ther under the
sea level . This study lay to appear the historical important and to study the variation
of environment and population which happened in the different periods , in the
beginning the Paleolithic until the later period , and to understand the environment ,
political and economical circumstances , which it can to influenced or limited in
human behavior from choosing , the settlement sits and than ( we could ) knowledge
of living ways and the tools which they used in there living a

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Publication Date
Sat Jun 01 2019
Journal Name
Journal Of Accounting And Financial Studies ( Jafs )
Investigate the effectiveness of investment in the electricity sector And its role in achieving sustainable development
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The provision of electric power is necessary for the advancement of the country's economy. It is the main engine of the economy and its various activities. It is an indicator of social welfare and it is considered as the basic pillars for achieving sustainable development (economic, social, environmental and institutional) by raising the levels of performance and meeting local needs. The problem of research was the absence of a program to audit the performance of the electricity sector contributes to ensure the application of sustainable development. The research was based on the hypothesis that the preparation of a proposed program to audit the performance of the electricity sector contributes to the achievement of The researchers sough

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Publication Date
Tue Sep 30 2025
Journal Name
3l The Southeast Asian Journal Of English Language Studies
Rhetoric in the Translation of Selected Kinship Terms in the Holy Quran into French and English
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Translating the Qur’anic real meaning into other languages is considered to be a unique challenge as it is deeply rooted in Arabic culture and language. Thus, this operation often loses the rhetoric and poetic beauty of the Qur’anic text, hindering a deep understanding of its spiritual and moral significance. This study constitutes a part of a comparison study of certain kinship terms in Qur’anic Arabic' abawayn / wâlidayn, zawj / ba'al, and imra’a / zawj / ṣaẖiba and their equivalents in French and English versions. It is actually about providing some details on these Arabic terms and their equivalents by examining how they have been used in the Qur’anic context to indicate specific meaning. It is divided into two main parts

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Publication Date
Mon Dec 05 2022
Journal Name
Journal Of Production And Industrial Engineering
The Use of Quantitative Techniques and Their Role in The Administrative Decision-Making Process in Organizations
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Due to the developments taking place in the field of communications, informatics systems and knowledge management in the current century, and the obligations and burdens imposed on the business organization to keep pace with these developments, the traditional methods of administrative decision-making are no longer feasible, as recent trends have emerged in management that focus on the need to rely on quantitative methods such as operations research.. The latter is one of the results of World War II, which appeared for the first time in Britain to manage war operations. The first method used in this field is the linear programming method. The use of operations research has developed greatly in the past years, and the methods of analysis in

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Publication Date
Mon Jun 01 2015
Journal Name
Journal Of Economics And Administrative Sciences
The Monitoring Role of the Governmental council in improving the performance of local Committees: Applied Research in the Wasit Governmental Council
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            The research aims to identify the elements of performance supervisory good and effective and availability in the Governmental council through examination and analysis of the reality and practice of censorship in this Council through study and evaluate the characteristics of the regulatory effective upon which the Governmental council in the performance of his work and knowledge of their adequacy by comparing the established criteria , and determine the effect of characteristics supervisory the performance standards for the Governmental council, Based search to two assumptions key to check the level of the relationship and the influence of the dimensions of the con

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Publication Date
Sun Sep 01 2019
Journal Name
Journal Of Accounting And Financial Studies ( Jafs )
The effect of accounting disclosure in the efficient performance of the tax authority: Applied research in the General Commission for Taxes
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               Starting with a problem of the weakness of accounting disclosure in some companies administration when preparing and presenting the financial reports which are submitted to the Tax authority. This problem impacts on Tax authority performance (The effect on the quality of the performance of the tax authority), because of the lack of conviction for the information contained in those reports, and the  failure to achieve accurate results in tax authority performance that leads to a negative impact on determining taxable income and affect tax revenue, as well as negative impact on  determining taxable income and affect tax revenue, as well as negati

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Publication Date
Fri Jul 01 2016
Journal Name
Journal Of Economics And Administrative Sciences
The Impact Of Application Of Jit In The Banking Sector On The Quality Of Banking Service
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Abstract 

          The research the impact of the application of some of the production system tools in the specified time, which can be adapted in the service sectors (banking sector) over the improvement and increase the quality of banking services, and highlights the research problem in the low quality of banking services provided to customers because of the reliance on traditional banking systems in the provision of services Because of the lack keep pace with global developments in the banking industry, and the goal of research is to clarify the applicability of the production system in the time specified in the service sector and th

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