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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 Feb 03 2019
Journal Name
Journal Of The College Of Education For Women
The Sufferings Of Afro-American Maids in Kathryn Stockett's The Help
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This research deals with the color bias and its effect on maids in Mississippi in Kathryn Stockett''s (2003) The Help. The ill-treatment and negligence of Afro-American maids received from the white women who employed them in Mississippi that must have affected directly or indirectly on their personality and may eventually lead to suffering. They live in an atmosphere of struggle to free themselves from the complicated relationships between black and white. Afro-American maids pledged to liberate themselves from social oppression by protesting through writing a book which chronicles their stories in slave masters’ homes to make their presence felt as human being equal to their white masters.

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Publication Date
Thu Jan 10 2013
Journal Name
Asian Journal Of English Studies
The Use of Restrictive Relative Clauses in Letters to the Editors
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A restrictive relative clause (RRC hereafter), which is also known as a defining relative clause, gives essential information about a noun that comes before it: without this clause the sentence wouldn’t make much sense. A RRC can be introduced by that, which, whose, who, or whom. Givon (1993, 1995), Fox (1987), Fox and Thompson (1990) state that a RCC is used for two main functions: grounding and description. When a RRC serves the function of linking the current referent to the preceding utterance in the discourse, it does a grounding function; and when the information coded in a RRC is associated with the prior proposition frame, the RRC does a proposition-linking grounding function. Furthermore, when a RRC is not used to ground a new di

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Publication Date
Sun Feb 10 2019
Journal Name
Iraqi Journal Of Physics
The role of atmospheric non-thermal plasma in the bacteria inactivation
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Non-thermal atmospheric pressure plasma has emerged as a
new promising tool in medicine and biology. In this work, A DBD
system was built as a source of atmospheric pressure non-thermal
Plasma suitable for clinical and biological applications. E. coli and
staphylococcus spp bacteria were exposed to the DBD plasma for a
period of time as inactivation (sterilization) process. A series of
experiments were achieved under different operating conditions. The
results showed that the inactivation, of the two kinds of bacteria, was
affected (increasing or decreasing) according to operation conditions
because they affects, as expected, the produced plasma properties
according to those conditions.

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Publication Date
Thu Mar 19 2015
Journal Name
Al-academy
The concept of Sustainable Environments in the UAE: عبد الصمد الخالدي
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Over last decade, rapid growth in economic and population accompanied with depletion of the energy resources lead to serious impacts on environment and humanity. This development coupled with active constructions, which in some examples ignore the impact on the environment and human activities. Therefore, principle of sustainability has required in order to reducing this negative impact on the environment and the humanity.In developing countries, it seems that there is a huge gap between the current construction practices and sustainable principle, which need more attention to clarify and define the problems in order to find suitable solutions before it comes more difficult and expensive. The study aims to choose one of the develo

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Publication Date
Thu Apr 30 2020
Journal Name
Journal Of Economics And Administrative Sciences
Requirements for the Application of IFRS 17 in the Iraqi Environment
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This research aims to address the most recent international standard in the field of insurance contracts, the International Financial Reporting Standard (IFRS17) and the theoretical framework of the standard in addition to the most important characteristics of the standard (IFRS17), as well as to identify the paragraphs of the modern standard, with the challenges its application in general and the use of the approach (inputs - operations - outputs) to present the challenges of its application in the Iraqi environment and specifically in the environment of Iraqi insurance sector companies (government), the research is based on the main premise that the identification of the requirements for the application of the International Fin

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Publication Date
Sat Feb 07 2026
Journal Name
Al–bahith Al–a'alami
THE ROLE OF PRESS ADVERTISING IN ENCOURAGING THE PUBLIC TO PURCHASE
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This research sheds light on how press advertising affects consumer behavior and draws attention to it by identifying the factors that influence the intellectual perception process or attention to it. The aim of the research was to identify the factors that help achieve the objectives of the press announcement. The aim of the research was to identify the factors that help to achieve the objectives of the press announcement. The research problem was identified in four questions that were answered through a questionnaire distributed to a sample of students of College of Mass Communication, University of Baghdad. Do newspaper advertisements meet the readers’ need to search for the req

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Publication Date
Tue Mar 30 2021
Journal Name
College Of Islamic Sciences
Problems distorting the divine books in the light of revealing interpretation
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Abstract

The research is presented according to an objective study on the ideological problems, especially the distortions that the divine scriptures have been subjected to under a false pretext that does not pertain to religion, namely that the heavenly books of the Torah and the Bible have been damaged or lost as a result of apostasy and persecution, and the writing of these books has been entrusted by people who have been bestowed Holiness, they have the testimony of the Church, so they distorted and omitted it in a manner suitable for securing their good and worldly gains, and the Holy Qur’an mentioned this explicitly, and they continued later, especially the Jews, in distorting the verses of the Holy Qur’an. This researc

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Publication Date
Tue Jun 01 2021
Journal Name
Political Sciences Journal
The Trust Factor of Oman’s Diplomacy in the US-Iranian Conflict
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من أجل فهم دور سلطنة عُمان في المفاوضات الإقليمية والوساطة وحل النزاعات يجب تقدير سياستها الخارجية، والتي سيتم تقييمها من أجل فهم كيفية نشأتها وتشكلها وأثر ذلك على مواقفها السياسية طوال سنوات حكم السلطان الراحل قابوس بن سعيد. وتقع عُمان في منطقة مضطربة، وقد طُلب منها في عدة مناسبات أن تعمل كمفاوض أو وسيط في الصراعات الإقليمية. سيبحث هذا البحث في كيفية قيام السلطنة بالوساطة الدولية، خاصة في الصراع الأمريكي

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Publication Date
Wed Jan 22 2020
Journal Name
Molecules
In Vivo and In Vitro Evaluation of the Protective Effects of Hesperidin in Lipopolysaccharide-Induced Inflammation and Cytotoxicity of Cell
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(1) Background: Plant flavonoids are efficient in preventing and treating various diseases. This study aimed to evaluate the ability of hesperidin, a flavonoid found in citrus fruits, in inhibiting lipopolysaccharide (LPS) induced inflammation, which induced lethal toxicity in vivo, and to evaluate its importance as an antitumor agent in breast cancer. The in vivo experiments revealed the protective effects of hesperidin against the negative LPS effects on the liver and spleen of male mice. (2) Methods: In the liver, the antioxidant activity was measured by estimating the concentration of glutathione (GSH) and catalase (CAT), whereas in spleen, the concentration of cytokines including IL-33 and TNF-α was measured. The in vitro expe

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Publication Date
Mon May 24 2021
Journal Name
Awej For Translation & Literary Studies
Embodied Oppression and Psychological Trauma: The Subjugation of O-lan's in Pearl Buck’s Novel the Good Earth
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