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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 Jan 21 2024
Journal Name
International Development Planning Review
THE ROLE OF ACADEMIC COACHES IN HANDBALL SKILL PERFORMANCE FROM THE POINT OF VIEW OF THEIR PLAYERS
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The aim of the study is to prepare a measure of the role of academic coaches in handball skill performance from the point of view of the researchers. The researchers used the descriptive approach in the research procedures as it is an appropriate approach in achieving the research objectives. The next question is: To what extent will the players benefit from the academic coach in developing their skill performance? This is the measure of the role of academic coaches. From 16 items, the research community included players (Al-Karkh Club - Al-Hashd Sports Club) and the number of players was (Al-Karkh 14 - Al-Hashd 14). The research sample was intentional and represented (the research community 100% The researchers concluded that measuring the

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Publication Date
Mon Jan 28 2019
Journal Name
Journal Of The College Of Education For Women
Relation Ship and Effect Of Jet Stream in Anti-Ciyclone in Influencing The Climate Of Iraq
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This study aimed to statement jet stream and its impact in the anti-cyclone affecting the climate of Iraq. Through the use of simple correlation coefficient ( Pearson ) that there is a very strong relationship between high- Siberian and both of the jet stream especially during the winter or over the stations of North . Therefore we, observe the relationship be significant in most of the winter months , spring and autumn . Statistically significant , but are different between station and another station , while the study come to another Anti-ciyclon have a real ,significant and statistically relationship corrclation . But this relationship is less than which found in are much less it with the Siberian high , it depends on the type of stat

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Publication Date
Mon Dec 25 2023
Journal Name
Journal Of Legal Sciences
The Principle of Prohibiting the Diversion of the Natural Course of International River Waters
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The research deals with the principle of the prohibition of international waterway diversion in the law of international watercourses. The research reviews individual and collective doctrinal efforts that have touched upon the principle as an internationally wrongful act because of its serious damage and consequences for downstream States. The research addresses the nature of the principle of the prohibition of diversion of international watercourses; its various effects; principles of international law establishing the principle of prohibition of diversion; and its application in State practice and international justice. This principle has been enshrined in most international treaties and judicial decisions. The principle of prohibition

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Publication Date
Thu Mar 01 2012
Journal Name
Journal Of Economics And Administrative Sciences
The Impact of Intellectual trends on the nature of the Economic Structure of Iraq
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The Impact of Intellectual trends on the nature of the Economic Structure of Iraq

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Publication Date
Sun Jan 01 2017
Journal Name
Journal Of The College Of Languages (jcl)
The Literary Animal and the Grotesque Survival in Ted Hughes’s “Thrushes”
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In his opus, Ted Hughes has annexed new and fresh territories of signification to the very notion of the literary animal. Building on the earlier modernist example of the Lawrencian legacy that dwells upon the question of animalism, Hughes seems to have stepped further into the terrain of the sheer struggle when, in his hands, the grotesquerie of survival and violence energizes the topos of the literary animal in his postmodern bestiary. In Hughes’s elemental poetic process this grotesquerie and violence stages the literary animal as a vital poetic device or motif that is finally restored to the primitive power of poetry. In his “Thrushes”, he thus defamiliarizes these tiny creatures’ acts of being to bring upfront into focus thi

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Publication Date
Sun Dec 10 2017
Journal Name
Al-academy
The speech communication btween the shape and content in commercial advertising
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The Main think that be kept by the speech communication as a concept traditionally being expressed on the subject or a certain idea of ​​a goal came on as needed functional addressed to recipients of benefits or likely to benefit from those rhetorical message through a speech importance and priority of the effect of not less than the effect of that letter, in science content role ends once you absorb it mentally, either in the art of design Valamadmon intellectual embodied through its interaction with the overall shape of the finished design, and often content is associated in the mind of the receiver through a letter communicative linked to the sense or the goal that meant the designer, and try to identify and explain. And meaning i

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Publication Date
Wed Jun 01 2022
Journal Name
Political Sciences Journal
The The US Pressure and Sanctions Policy in Changing Iran's Conduct
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This research aims to analyze the impact of the United States policy of pressure and sanctions on changing Iran's conduct. Since the Islamic Revolution of Iran in 1979, the US has continuously pursued various policies towards Iran, aiming to change the regime by force or isolate it politically and economically. The main research question lies in the following: To what extent does the US pressure policy and its sanctions affect the conduct Iran?. This research discusses that the more there are economic and political alternatives to Iran, the more it will be challenging the US demands. Moreover, the more the US pursues a negotiating policy based on mutual interests, the more Iran will positively respond to American demands.

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Publication Date
Sat Feb 02 2019
Journal Name
Journal Of The College Of Education For Women
Bridging the Gap between Graphemes and Phonemes in the Phonetic Transcription
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Bridging the Gap between Graphemes and Phonemes in the Phonetic Transcription

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Publication Date
Mon Sep 30 2019
Journal Name
College Of Islamic Sciences
Attitudes and prayers Ahl al-Bayt peace be upon them to poets In the Umayyad and Abbasid periods Objective study
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Poetry occupied the Arabs in a unique position, especially in the era; ignorant, Umayyad and Abbasid, in addition to its literary and aesthetic dimensions, it is at the forefront of tools and media at the time. The poet appointed society and poetry Diwan Arabs records their exploits and virtues and their valor in the wars... The Prophet Muhammad () realized the importance of poetry, so he took advantage of him in the libel for his Islamic call. In the Umayyad and Abbasid states, poetry had a clear role in social, literary and political life, as the ruling authority used its influence on many poets to be media to support its political theory, by praising the Caliph and his aides, and exposing those who dissented and opposing them. The

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Publication Date
Sat Dec 01 2018
Journal Name
Journal Of Economics And Administrative Sciences
Structural Imbalances and their impact on Sectoral Growth and Employment in Iraqi Economy for the period 2003-2015: Analytical study.
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Abstract:

     The objective of this study, is to attempt to explain the reality of the Structural Imbalances in the Iraqi Economy during the period of research, by providing a quantitative analysis of the most important types of Imbalances, Which are represented by the disruption in the Productive Structure, the imbalance of the structure of Public Budget, and the imbalance of the Structure of Trade. The problem of the research, is the fact that the economy structure in Iraq has long suffered from an Imbalances in its economic structure, which are represented in the unequal relations between its constituent elements, according to the proportions levels defined by the economic theory.

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