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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
Wed Dec 24 2025
Journal Name
Journal Of Physical Education
The Effect Of Absolute Strength Training On Knee Injuries Rehabilitation And Special Strength In Muay Thai Fighters
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Publication Date
Tue Mar 30 2021
Journal Name
College Of Islamic Sciences
Taking Over The Judiciary By Women And The Position Of Law From That: مثالا
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لمقدمة

     الحمد لله رب العالمين والصلاة والسلام على سيد الأنبياء والمرسلين نبينا محمد صلى الله عليه وسلم وعلى  واصحابه أجمعين  ومن تبعهم وأهتدى بهداهم الى يوم الدين اما بعد :

        فوظيفة القضاء وظيفة سامية يراد منها اقامة العدل ولا يستقيم حالهم الا به دفعاّ للظلم ، ولقد اولى النبي صلى الله عليه وآله وسلم ومن بعده الخلفاء الراشدون

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Publication Date
Mon Oct 01 2018
Journal Name
2018 International Conference On Advanced Science And Engineering (icoase)
Performance of BCH and RS Codes in MIMO System Using MPFEC Diversity Technique
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Publication Date
Tue Sep 03 2019
Journal Name
Rawal Medical Journal
Evaluation of Radial Nerve Injury Associated with Closed Humeral Shaft Fracture by Early Pre-operative Ultrasonic Evaluation and Correlation with Surgical Exploration
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Traumatic radial nerve injury in humeral shaft fracture is the most common traumatic nerve injury in long-bone fracture, with overall prevalence 2-18%, ranging from traction to complete transection. Spontaneous recovery may reach 88%. The aim of the study is to assess the sensitivity & specificity of the ultrasound to detect the radial nerve injury and to see if this can be used as a diagnostic test. This is a prospective study on 17 adult patients with a closed fracture of the humeral shaft, dividing into two groups, the first group of 7 patients had signs and symptoms of radial nerve palsy at presentation and the second group of 10 patients had intact radial nerve function was considered as a control group. All these patients had at leas

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Publication Date
Tue Dec 16 2008
Journal Name
Journal Of Planner And Development
Evaluation of the efficiency of the regional transport network of the district center of Mahmudiya
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The Study aims at evaluating the efficiency of the regional transportation net in Al-mahmoodiya Qadaa center. The bus station of the Qadaa center is suffering from heavy traffic jam, which is due to the ongoing movement of the adjacent provinces, particularly the small cities. They vary in the degree of their link by the regional transportation net that links the province with the centers of big cities. That affects the traffic flow of the civilians of these cities and their daily activities in hierarchical way To achieve the purpose of the study, a questionnaire has been constructed to collect data through selecting a random sample including the passengers who are coming to the bus station in Al-Mahmoodiya center to know the flo

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Publication Date
Wed Jan 01 2014
Journal Name
Journal Of The College Of Languages (jcl)
“The Theme of Deliberate Contrasting Coincidence in Beckett's "All That Fall"”
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In most of Beckett’s plays , there are prominent elements of absurdity that are landmarks of his style and the way of his writing like : the physical and the spiritual decay of characters, the disintegration of language as it becomes no longer a means of human communication because there is an inability to establish any kind of mental contact among them. These elements are quite apparent in Beckett’s “All That Fall”. The play exhibits a list of  conflicts: one is between powerful forces as that between the force of life represented by Maddy and the forces of death represented by Dan .The second is  the conflict and contempt between the old generation and the new one in the case of Dan’s desire to kill the boy fetching

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Publication Date
Wed Aug 03 2022
Journal Name
Journal Of Accounting And Financial Studies ( Jafs )
The role of the currency sale window in the stability of the dinar exchange rate and its reflection on inflation
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The: currency Auction is one of the monetary policy tools created after 2003, in order to keep pace with the changes that the monetary and financial policies will witness from financial openness and expectations of high levels of liquidity after international economic restrictions. It is necessary to re-evaluate the work of the currency Auction from time to time and observation its efficiency in adjustment the exchange rate And its reflection on the general level of prices as one of the objectives of its inception, and during the analytical aspect, it was confirmed that the currency Auction for selling the currency had a major role in adjustment the exchange rate and controlling inflation levels, due to the market’s dependence

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Publication Date
Mon May 01 2023
Journal Name
Journal Of Engineering
Parametric Analysis of Surface Roughness and Metal Removal Rate during Electrical Discharge Machining of O1 Tool Steel
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This work studies the impact of input machining parameters of Electrical Discharge Machining (EDM) on the machining process performance. Tool steel O1 was selected as the workpiece material, copper as the electrode material, and kerosene as the dielectric medium. Experimental runs have been carried out with a Design of Experiment (DOE) technique. Twenty tests are accomplished with the current range of (18 to 24 Ampere), a pulse duration range of (150 to 200 µs), and a pulse-off time range of (25 to 75 µs). Based upon the experimental study's output results, the EDM parameter's effect (voltage of power supply, discharge current, pulse duration, and pulse pause interval) on the responses of the process represented by sur

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Publication Date
Wed Dec 30 2020
Journal Name
Journal Of Accounting And Financial Studies ( Jafs )
The effect of salary Domiciliation in the rate of return on assets (ROA): Applied research of a sample of Iraqi banks
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Abstract

The research attempted to find an explanation and solution to a problem related to the fluctuation and decrease In the rate of return on assets for the research sample banks during the duration of the research, The search started from the hypothesis that, The effect of salary Domiciliation on the banking profitability of a sample of Iraqi banks participating in the salary settlement system for the period (2016-2019),The research used the descriptive historical approach, the quantitative analytical approach and the statistical approach. The research reached a set of conclusions, the most important of which is The effect of salary Domiciliation on banking profitability was achieved in three banks

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Publication Date
Sat Dec 30 2023
Journal Name
Basrah Journal Of Surgery
Can Hyaluronic acid gel enhance wound healing faster than Advanced Platelets Rich Fibrin following surgical removal of impacted mandibular third molars? A Randomized Controlled Trial
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