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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 May 01 2018
Journal Name
Journal Of Physics: Conference Series
Photoluminescence Spectra From The Direct Energy Gap of a-SiQDs
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Publication Date
Fri Dec 23 2022
Journal Name
Iraqi Journal Of Pharmaceutical Sciences ( P-issn 1683 - 3597 E-issn 2521 - 3512)
Plant-derived Molecules for the Treatment of Tuberculosis: A Review
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Synthetic anti-TB drugs are being used to treat tuberculosis (TB) as they are effective, however, they are accompanied by many side effects. The disease has remained largely uncured till date. The use of plant extracts or phytochemicals along with the anti-TB drugs is a very attractive strategy to make the treatment more effective as phytochemicals have no side-effects, are much less toxic than synthetic anti-TB drugs, are safe to use and most importantly, do not produce resistant strains as opposed to synthetic anti-TB drugs. Approximately 420,000 plant species have been identified globally and among them only a few have been explored for their therapeutic potential. Traditional medicine in different parts of the world has employed crud

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Publication Date
Mon Aug 01 2011
Journal Name
Journal Of Engineering
EXPERIMENTAL OBSERVATIONS ON THE BEHAVIOR OF A PILED RAFT FOUNDATION
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The piled raft is a geotechnical composite construction consisting of three elements: piles, raft and soil.
In the design of piled rafts, the load shared between the piles and the raft, and the piles are used up to a
load level that can be of the same order of magnitude as the bearing capacity of a comparable single
pile or even greater. Therefore, the piled raft foundation allows reduction of settlements in a very
economic way as compared to traditional foundation concepts.
This paper presents experimental study to investigate the behavior of piled raft system in sandy
soil. A small scale “prototype” model was tested in a sand box with load applied to the system through
a compression machine. The settlement was

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Publication Date
Tue Aug 01 2023
Journal Name
Nauchforum
COGNITIVE ELEMENTS AND CRITERIA OF THE INFLECTIONAL SYSTEM OF RUSSIAN AND ARABIC LANGUAGUES IN THE PROCCES OF VERBAL COMMUNICATION (COGNUTIVE ANALYSIS OF LANGUAGE STRUCTURE)
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In this paper we study the selection of cognitive elements and criteria of the inflectional structure of the Russian and Arabic languages in the process of speech communication. Phonetic-physiological principle is the main parameter by which the elements and criteria of cognitive activity in the presented study are distinguished. On the basis of the above mentioned parameter, we select the investigated criteria and elements. The first criterion is semantic, reflects the accordance of the elements of thinking to sound combinations in the studied languages, and allows us to distinguish the second criterion – morphonological. The second criterion depends on the phonetic changes of these combinations occurring in the process of speech activit

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Publication Date
Mon Nov 01 2021
Journal Name
Water Research
Fate and removal of silver nanoparticles during sludge conditioning and their impact on soil health after simulated land application
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Publication Date
Sun Sep 15 2019
Journal Name
Al-academy
Aesthetic and Functional Dimensions of Environmental Waste in the Products of Students of the Department of Art Education: فردوس خضر الجوفي
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The practice of art is an inevitable result imposed by the circumstances surrounding the human being, as he needs some knowledge associated with raw materials, tools and methods to develop skills in the formation of elements of the work of art in new ways that give a decent artistic appearance to the work of art. Through the exploratory study carried out by the researcher, which included asking the following question to the third grade students, Department of Art Education:

What types of materials are used in handicrafts and from which sources are they obtained? Through the answers, the problem of research was founded as follows:

-Are the products of students of the Department of Art Education in the handicraft material d

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Publication Date
Mon Feb 01 2021
Journal Name
Indian Journal Of Ecology
Effect of sedimentary source on the properties of sphericity and roundness of feldspar minerals in some soils of the alluvial plain
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This study was conducted on the effect of the sedimentary source (the sediments coming from both the Iraqi-Iranian borderline and the Tigris river) on the optical and textural features, especially sphericity and roundness of feldspar minerals (potassium and plagioclase types) in soils of the southern part of the alluvial plain. Eight pedons were selected to represent the study area, five of them represented sediments coming from the borderline, which included pedons of (Badra, Taj Al-Din, Al-Shihabi, Jassan, and Galati), while two of them represent the sediments of the Tigris River (Essaouira, Al-Dabouni), the pedon of Ali Al-Gharbi was represented the mixing area of sediments of all the floods coming from the borderline and the sediments o

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Publication Date
Mon Jan 28 2019
Journal Name
Journal Of Accounting And Financial Studies ( Jafs )
Economic analysis of the investment of human capital and the policy of privatization
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The research problem is dedicated to investigate reservoirs irrational economic behavior adopted by the ruling elites in developing countries about the investment methodology of human capital and operating policies is based on the terms of reference of economic theory and standards governing the market, which led to a chronic structural imbalance in the workforce structure and lack of consistency with different production structure, in turn, which had a reported effects in the emergence of the phenomenon of unemployment and that they involved a certain privacy, as has become the issues of unemployment and employment in the various countries of the world are issues more important due to the presence of large numbers of the workforce in th

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Publication Date
Wed Mar 15 2023
Journal Name
Al-academy
The gratifications of local television sports programs from the audience's point of view Analytical study for the period from 1/7/2022 to 01/10/2022
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The issue of sports media and its role in winning sports and non-sports fans and unifying them towards various issues and events is one of the important topics that have begun to occupy many countries and governments in the world and allocate appropriate spaces for it and provide it with sufficient funds and budgets to advance this reality...

Especially since the concept of the sports official has It changed a lot and turned into an economic concept rather than a sport one through the investment in the field of sports and the entry of capital and contributes to the prosperity of the countries interested in this field.

It is important that includes profit and loss in addition to knowing how to employ and win the masses and e

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Publication Date
Wed Jan 01 2014
Journal Name
Scienceasia
A combined compact genetic algorithm and local search method for optimizing the ARMA(1,1) model of a likelihood estimator
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In this paper, a compact genetic algorithm (CGA) is enhanced by integrating its selection strategy with a steepest descent algorithm (SDA) as a local search method to give I-CGA-SDA. This system is an attempt to avoid the large CPU time and computational complexity of the standard genetic algorithm. Here, CGA dramatically reduces the number of bits required to store the population and has a faster convergence. Consequently, this integrated system is used to optimize the maximum likelihood function lnL(φ1, θ1) of the mixed model. Simulation results based on MSE were compared with those obtained from the SDA and showed that the hybrid genetic algorithm (HGA) and I-CGA-SDA can give a good estimator of (φ1, θ1) for the ARMA(1,1) model. Anot

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