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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
Wed Jan 01 2025
Journal Name
Agricultural Engineering
The Effect of Design and the Accelerated Wear Test of Agricultural Nozzles on the Resulting Droplet Size
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Abstract<p>The change in the size of the droplets during the pesticide application process could have a negative impact on the percentage of drift or the losses of pesticides to the environment. One of the factors that could affect the droplet size produced from a single nozzle is the internal design of the nozzle itself, in addition to the wear of the nozzle orifice as a result of the usage time. In this research, three types of nozzles with different internal designs were used (Turbo TeeJet (TT), Turbo TwinJet (TTj 6011003), and Drift Guard (DG 11003)). The nozzles were subjected to an accelerated wear test for one hundred hours, and different droplet size parameters (Dv 0.1, Dv 0.5, Dv 0.9), </p> ... Show More
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Publication Date
Sun Feb 10 2019
Journal Name
Journal Of The College Of Education For Women
The face of the pressures of life styles to Riyadh parameters and the relationship with some variables
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I noticed a researcher while working in the kindergarten that there is a group of
parameters resort to the use of different methods may be some undesirable and some
undesirable So felt researcher detection methods used parameters Riyadh in the face of the
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Publication Date
Fri Mar 01 2019
Journal Name
Al-khwarizmi Engineering Journal
The Effect of Adding Carboxymethyl Cellulose and Zinc Sulfate on the Corrosion Characteristics of the Drilling Fluid
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Drilling solutions can be considered as an intricate mixture comprising of number of chemical additives which aid specific needs such as controlling the rheological properties and reducing corrosion. Inhibitors are substances that are added in small concentrations to corrosive environment to decrease the corrosion. Their applications can be found in drilling equipments. The effect of adding Zinc Sulphate and Carboxymethyl Cellulose to study their influence on the corrosion of carbon steel in Bentonite mud has been evaluated using Weight Loss Technique. This study focuses on determining rheological properties and corrosion characteristics. Results show CMC and ZnSO4 work as inhibitors when added to the Bentonite with inhibition

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Publication Date
Wed Apr 01 2015
Journal Name
Journal Of Economics And Administrative Sciences
Public expenditures transferring and its role in the redistribution of income with particular reference to the experiences of elected
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Publication Date
Mon Feb 02 2026
Journal Name
Journal Of Physical Education
The Effect of Using Teaching Aid on the Development of Straight Forehand and Backhand Shot Performance in Lawn Tennis
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The problem of the research lies in finding aiding means that improve and facilitate learning artistic skills during the main part of a teaching sessions due to their great importance in developing the accuracy of forehand and backhand skills in tennis. Players are usually faced with difficulties at the beginning of learning due to lack of coordination in ball striking thus including a teaching aid will have a positive effect on learning some forehand and backhand skills. The research aimed at designing exercises using teaching aid in tennis as well as identifying the effect of these exercises on the accuracy of performing forehand and backhand shots in tennis. The researcher used the experimental method on (38) tennis players from Al Zewra

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Publication Date
Thu Nov 14 2019
Journal Name
Advances In Intelligent Systems And Computing
The Application of Bus Rapid Transit System in the City of Baquba and Its Impact on Reducing Daily Trips
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Sat Jun 15 2024
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THE ROLE OF FUNGAL INFECTIONS IN THE PATHOGENESIS OF DIALYSIS-DEPENDENT AND NON-DIALYSIS-DEPENDENT PATIENTS WITH KIDNEY DISEASE
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Publication Date
Sun Dec 02 2012
Journal Name
دراسات عربية في التربية وعلم النفس
The effectiveness of environmental enrichment activities in the achievement of chemistry and environmental awareness for fifth-grade science students
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Publication Date
Thu Apr 02 2020
Journal Name
Iop Conference Series: Materials Science And Engineering
The effects of additives in to heat treatment temperature and time on the crystallinity of lithium silicate glass-ceramic
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Publication Date
Thu Apr 01 2021
Journal Name
Iop Conference Series: Earth And Environmental Science
The effect of some environmental variables on the abundance and distribution of aquatic macrophytes in Al-Hawizeh marsh, Iraq
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