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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
Mon Sep 30 2019
Journal Name
College Of Islamic Sciences
Provisions of payment of the questioner in Islamic jurisprudence
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God has honored the man with life and decent living and warned against attacking anything that violates his sanctity without a legitimate right. Our Islamic Shari'ah has the rights to preserve the right of a Muslim in the event of any harm.

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Publication Date
Mon May 21 2007
Journal Name
Journal Of Planner And Development
Role of functional relations in the identification of regions
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The region is defined by the spatial dimension, which consists of a set of stabilizers (towns and villages). The concept of the territory requires conditions on the nature of functional relations and the mutual influence of the regions within the region. Any territory must be based on the interdependence and interaction between the mother city and its surrounding countryside and cities, and when the interdependence is strong and the interaction is clear, it helps to define the territory. The regions are divided on different bases. There are geographically or national homogeneous regions, and there are cultural regions that want to preserve their culture in terms of language or religion. There are administrative regions to manage

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Publication Date
Thu Jan 10 2019
Journal Name
Journal Of The College Of Education For Women
Types of parallelism in the poetry of Mahmoud Darwish
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This research deals with the study of types of parallelism in contemporary Arabic poetry and took the hair Mahmoud Darwish, a model for the study has been the goal of research to clarify the term parallelism and the statement of the most important types, said evidence of that in the poetry of Mahmoud Darwish

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Publication Date
Tue Jan 01 2019
Journal Name
Energy Procedia
Studying The Effect of The Type of Substrate on The Structural, Morphology and Optical Properties of TiO2 Thin Films Prepared by RF Magnetron Sputtering
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Publication Date
Fri Sep 30 2022
Journal Name
College Of Islamic Sciences
The jurisprudential aspects of Imam Abu al-Fayyadh al-Basri And its impact on the Shafi’i school of thought, on the rulings of worship
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Summary of the jurisprudence research

  Praise be to God, Lord of the Worlds, and prayers and peace be upon the Master of the Messengers, our master Muhammad, and upon his pure family, and his ignorant and ignorant companions, and those who followed them in goodness until the Day of Judgment.

 Then:

 The many jurisprudential aspects that the Shafi’i imams said are of great importance, because these aspects are nothing but the opinions of venerable jurists who have reached a high degree of knowledge until they have become among the owners of faces. And among them are the Shafi’i jurists, the jurists may differ among themselves, either because there is no text about their imam in a

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Publication Date
Sat Sep 30 2023
Journal Name
Modern Sport
The effect of Tabata exercises on the development of stamina and achievement for female athletes running 100m hurdles under the age of 18 years
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يعد علم التدريب الرياضي الحديث عملية تربوية علمية مبنية على اسس صحيحة هدفها وصول اللاعبين الى التكامل في الاداء الفني وهذا يتم عن طريق التأثير المنظم والدقيق بواسطة استعمال التمارين البدنية التي تحدث تغيرات خاصة في عمل اعضاء واجهزة جسم الرياضي والتي بدورها تؤدي الى رفع كفاءة الاعضاء والاجهزة لتحقيق الانجازات الرياضية العالية ولقد استعملت الباحثتان اسلوب حديث من اساليب التدريب الرياضي من اجل تطوير تحم

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Publication Date
Wed Nov 01 2017
Journal Name
Journal Of Economics And Administrative Sciences
Depending the Total Quality Management Philosophy To Develop Lean Manufacturing Systems: Case Study In the General Company for Heavy Engineering Equipments
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The continued acceleration in the business environment has led to the need for organizations great attention to quality applied in organizations to meet the needs of customers and stay in the market for as long as possible.

Search launched from the underlying problem is the presence of concentrations of defects and waste plaguing the company and to achieve the goal of the study detects the level of quality applied in the factory vessels and reservoirs of the General Company for Heavy Engineering Equipment, As well as calculate wastage rates occurring in the production process and find a relationship between the level of quality and ratios defective in each type of waste, it has been used quantitative meas

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Publication Date
Tue Jan 01 2019
Journal Name
Indian Journal Of Public Health Research &amp; Development
The Effect of Special Exercises for those with (Cognitive Concentration) in the Development of Motor Satisfaction and Learning Some Types of Scoring Basketball for Students
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The importance of the research in the preparation of special exercises to develop some types of basketball scoring as a contribution to help the physical education teacher to find successful educational alternatives. The purpose of the study was to prepare special exercises for the cognitive (cognitive) survey in the development of motor satisfaction and learning some types of Scoring for basketball for students. Learn about the effect of cognitive exercises in cognitive development in students. The survey included students from the first stage of the Faculty of Physical Education and Sports Science \ University of Diyala (159) divided into 6 people. The sample was randomized by (b) and (b) D) and after dispersion by the standard method In

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Publication Date
Fri Oct 30 2020
Journal Name
Journal Of Economics And Administrative Sciences
Influence of behavioural implication of information on the selection of accounting methods and their reflection on investor's decisions field study on Iraq stock exchange
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The research aims to highlight on the behavioural approach in accounting, and clarify the behavioural implications of the main activities of accounting, and clarify the concept of information inductance within the framework of the behavioural approach and its impact on preparing financial statements. And that the impact of financial information on the behaviour of investment decision-makers, and to achieve the goals of the research, the researcher prepared a questionnaire according to Likert five-step scale, and he took into consideration in preparing it in line with the characteristics of the study community, and that the target community for this questionnaire is the investors in the Iraq Stock Exchange. The researcher reached

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Publication Date
Mon Nov 03 2014
Journal Name
Iraqi Journal Of Physics
STVI calculating the changes in vegetable cover for a vegetated environment in west Iraq
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