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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 Jul 01 2014
Journal Name
Sage Open
Individual Mobility and the Sense of “Deadlock”
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Individual mobility is an outcome of the rapid changes in life; it is revealed in particular literary works within the end of the 19th century. Mobility is clearer in modern time as the individual has become physically freer in his movement. But the individual’s freedom is often conditioned by restrictions. Usually, change stimulates individuals to obtain new structure of feeling; the individual mocks or rages against institutions, or he would comply, suffering rapid personal deterioration as he faces effective stability or institutions. There is a continuous sense of “deadlock.” Sylvia Plath’s novel reflects the depression of an intellectual young woman who fails to find her right path muddled by an inconsistent, confusing

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Publication Date
Wed May 06 2015
Journal Name
Journal Of Social Science Research
The Syntactic and Concurrent Aspects of Emphasizers
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The reinforcing effect of emphasizers can hardly be denied, hence their importance , hence the justification for writing this paper. As a particular type of adverbials , emphasizers form part of a major syntactic class. This study, thus, introduces the topic by first discussing a grammatical category characterized by being mobile and optional. The paper duly shows the scaling effect of emphasizers, their kinds and the transformational selectional rules that are operative in moving them to the right or left of the VP. It also handles their syntactic role as modifiers, their syntactic features,their occurrence or non- occurrence with negation and imperative and the position they occupy in the sentence. The paper also dwells on the agr

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Publication Date
Wed Aug 01 2018
Journal Name
Journal Of Economics And Administrative Sciences
(Energy alternatives and the possibility of substitution)
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Many of the signs that the global energy system indicate the start of a period of transition from total dependence on fossil energy sources, especially oil, into a new era in which alternative energy sources play an important role in meeting the growing needs of energy demand, so sought many of the developed countries through research the studies carried out to try to bring renewable energy sources and non-renewable (shale oil, oil sands, solar energy, wind energy .... etc) replace traditional fossil energy sources (oil, gas, coal) and despite the recent availability dramatically and spread throughout the the world, but they are going to dry up in the foreseeable future. So many countries, especially the developed sought to find

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Publication Date
Fri Jan 15 2021
Journal Name
Psychology And Education Journal
Property and Possession in Gayl Jones’s Novel Corregidora: A Study in African American Literature and Literary Theory
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the traumatic memory of their ancestors. The novel navigates sites of trauma, memory, and blues music while resisting the bourgeoisie-capitalist relationships that permeated not only white society but also African American communities. Jones’s novel presents the plight of an African American woman, Ursa, caught between the memory of her enslaved foremothers and her life in an emancipated world. The physical and spiritual exploitation of African American women who bear witness to the history of slavery in Corregidora materializes black women’s individuality. This article is framed by trauma studies as well as the Marxists’ concepts of commodification, accumulation, and production. Ursa, one of the Corregidora women, represents

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Publication Date
Tue Feb 17 2026
Journal Name
Journal Of Physical Education
The Effect of Special Exercises Using Rubber Ropes on The Development of Some Physical Abilities and Achievement in F56 Female Discuses Thrower Class
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Publication Date
Thu Apr 01 2021
Journal Name
Biochemical And Cellular Archives
Evaluation the Effect of Allium Sativum (garlic) oil on The Expression of Maz E and Maz F Genes in Escherichia Coli Clinical Isolates
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Publication Date
Sun Mar 03 2013
Journal Name
Baghdad Science Journal
The ability of Pisum sativum plant to use tricalcium super phosphate (TSP) in the presence and absence of mycorrhizal fungi under field conditions
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Efficiency of Pisum sativum plants in using tricalcium super phosphate (TSP) in presence and absence of mycorrhizal fungi was evaluated in the field experiment in College of Science / Al-Mustansiriyah University. The experiment comprised of (6) treatments prepared from the interaction of two levels of inoculation [non-inoculation with fungus F0 and inoculation with Glomus mosseae fungus (F1)]. And three levels of phosphorus: 0,20,40 Kg P/ha. The experimental size was (1x2)m. Irrigation and hand-weeding were done when needed. The following plant measurements were recorded: (Shoots dry weight, concentration of N and P% in addition to percentage of root infection with mycorrhizal fungi at flowering 50% of plants. The re

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Publication Date
Sun Dec 01 2019
Journal Name
Restaurant Business
The role of using fair value on relevance and representation faithfulness of accounting information in accordance with the common conceptual framework (FASB-IASB)
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The global trend towards the use of fair value accounting is increasing, so the current study aimed to maximize the impact of fair value application on achieving relevance and representation faithfulness of accounting information in accordance with the common conceptual framework. To achieve the objective of this study, the researcher has determined in the theoretical framework the relationship of fair value with the characteristics of relevance and representation faithfulness of accounting information and the extent of achieving these characteristics, as well as conducting a field study by preparing a questionnaire distributed to a sample of academics (50) and auditors (50) with a total number of selected participants (100) of acad

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Publication Date
Fri May 15 2009
Journal Name
Journal Of Planner And Development
Preservation of heritage markets within an integrated framework to preserve the urban heritage in the historical centers of cities (selected models and experiments)
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This research discusses the rehabilitation of heritage markets in the historical centers of Islamic Arab cities and their use in the field of cultural tourism as one of the most important tourist attractions and the subsequent revival of the national economy in addition to preserving the urban heritage as these markets part of the historical centers of cities. The research also discusses the preservation of the continuity of heritage markets as a product of cultural heritage value within an integrated framework to preserve the urban heritage in the historic centers of cities. The study then reviews a number of experiences of Arab and Islamic countries in the field of preserving and rehabilitating heritage markets, which qualify them to b

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Publication Date
Wed Jan 01 2025
Journal Name
International Journal Of Physiology, Sports And Physical Education
The effect of compound exercises supported by information technology (GPS Ubiko and Polar verity senses) on the development of endurance in football players
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