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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 Aug 01 2017
Journal Name
Journal Of Economics And Administrative Sciences
Measure the level of banking performance in accordance with the e-marketing and total quality management requirements
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Acquires Find importance of the overall quality and e-marketing management have become important factors in evaluating the performance of banks, which are related to the life of the community intimately, so it is important that the banks applying comprehensive quality and e-marketing management requirements in order to maintain their performance and determine their level, as well as the manifest importance of research in part, practical linking the requirements of total quality management and banking performance on the one hand and between the e-marketing and performance banking on the other hand, through the provision of scientific bases that can be based on the banks in question, as it kicks off the research problem in that mos

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Publication Date
Sat Sep 01 2018
Journal Name
Journal Of Al-nahrain University Of Science
Contaminated Fungi in the Biology Department laboratories and Antagonistic Potentiality of MyrtrusCommunisVolatile oil Against the Isolated Fungi
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Publication Date
Thu Jan 31 2019
Journal Name
Journal Of The College Of Education For Women
The historical presence of Arab tribes and clans in the administratire regions (disputed ) ) 1800 m -1921 m)
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(disputed areas) before the establishment of the national government in Iraq in 1921, had to search for Arab tribes and clans in which the recipe group is available as a social organization coherent based on the foundations of several of them tribalism and her Land relates know Deira in those areas during the period that preceded the establishment of the national government in Iraq in 1921, and based on the inter girls primary sources and published mostly before the establishment of the national government in Iraq, the source of their information search and direct inquiry.
Research has proved that the tribes and clans of Arab exist in all districts described by (disputed), except (judicial Akre and Tilkaif) and varying degrees of time

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Publication Date
Mon Mar 15 2021
Journal Name
Al-academy
The art Formation and its aesthetic role in the design of digital commercial advertising: سند فؤاد محمد
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Digital commercial advertising depends on artistic formations to achieve attraction and arousal of attention, which is one of the most important communication factors that the designer seeks to achieve and is considered a key key to recognizing the beauty of the topic and its functional value. Reframe formal vocabulary.
The research included the introduction and includes the research problem and the need for it, which focused on the following question: What is the aesthetic role of artistic formation in the design of commercial advertising?
The aim of the research was: To reveal the aesthetic role of artistic formation in commercial advertising.
It also included the importance of research and research boundaries, as well as def

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Publication Date
Wed Jun 14 2023
Journal Name
Al-academy
Social Graphic Design and its Reflections on The Practices of The Saudi Designer in Designing Awareness Posters
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The concept of social graphic design is one of the most critical areas that highlight the designer's knowledge of social responsibility by employing design skills in community awareness. This study focused on defining social graphic design, the meaning, practices, and strategies for designing awareness posters. This study reviewed two examples of awareness posters that reflect the Saudi designer's practices. The results summarized that social graphic design is a concept not taught directly but gained from permanent practice in designing awareness posters that interact with community issues. The designer's understanding of his social events and their sensing in the visual form of a poster reflects the designer's social awareness. Social g

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Publication Date
Tue Mar 19 2019
Journal Name
Political Sciences Journal
Dialectical relationship between the civil state and the application of Sharia In contemporary Islamic political thought ج
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The political movements of Islam are among the most prominent phenomena of the popular uprisings witnessed by the Arab world. However, this rise and the rise of some movements led to many problems on the political theses of Islam, especially those associated with the ideas of Islamic ideologues and their slogan Legitimacy and the authorities as the origin of the divine, and said the application to achieve the Islamic solution, and then became the state in theses of some Islamists a tool to apply the law and then the preservation of religion.

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Publication Date
Wed Aug 17 2022
Journal Name
Aip Conference Proceedings
The effect of using Gaussian, Kurtosis and LogCosh as kernels in ICA on the satellite classification accuracy
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This study focusses on the effect of using ICA transform on the classification accuracy of satellite images using the maximum likelihood classifier. The study area represents an agricultural area north of the capital Baghdad - Iraq, as it was captured by the Landsat 8 satellite on 12 January 2021, where the bands of the OLI sensor were used. A field visit was made to a variety of classes that represent the landcover of the study area and the geographical location of these classes was recorded. Gaussian, Kurtosis, and LogCosh kernels were used to perform the ICA transform of the OLI Landsat 8 image. Different training sets were made for each of the ICA and Landsat 8 images separately that used in the classification phase, and used to calcula

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Publication Date
Tue Jun 30 2020
Journal Name
Journal Of Economics And Administrative Sciences
The role of strategic management accounting and its impact on the competitive advantage in Jordanian industrial companies
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This study aimed to recognize and understand the concept of strategic management accounting (SMA) and how it's the effect on the competitive advantage for industrial companies in Jordan. The study's importance arises due to the lack of Arab studies that dealt with this topic, in addition to the important and vital role of strategic management accounting on companies that represent the artery of the decision-making process, and to identify the benefits associated with SMA technology. The necessary data were collected through the literature review and theoretical study of the references that relevant to the study subject, in addition to a questionnaire developed for this purpose, the study used (124) out of (250) questionnaires tha

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Crossref
Publication Date
Mon Aug 28 2023
Journal Name
Journal Of Planner And Development
The role of environmental taxation and environmental incentives to reduce environmental pollution manifestations in the urban environment
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        The aim of studying the role of environmental taxation is to reduce or mitigate the problem of environmental pollution and obtain a clean environment. And the importance of research lies in the fact that environmental taxation is one of the basic tools to achieve environmental balance. As it is considered one of the sustainable economic tools that focuses on the concept of environmental taxes and fees. Therefore, the incentives stimulated institutions to invest in clean energy and use environmentally friendly machines. Through it, the rules of the competition are updated in favor of organizations that respect the environment so that they can obtain a green competitive advantage. And that the mai

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Publication Date
Sun Aug 30 2015
Journal Name
Statistical Analysis Of The Relations Between Api,specific Gravity And Sulfur Content In The Universal Crude Oil
Statistical Analysis of the Relations between API, Specific Gravity and Sulfur Content in the Universal Crude Oil
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