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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 Feb 01 2017
Journal Name
Journal Of Economics And Administrative Sciences
The Reflection Of The Financial Reporting Of Intellectual Capital Investment Decisions
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Abstract

The intellectual capital an important variable in the equation of the success of seeking economic units to achieve a competitive advantage, since it is a real capital for economic unity it constitutes a strategic importance as the main source to achieve high profitability in the economic unit and highlights the importance of showing intellectual capital components of the main Represent of human capital and structural capital and relational capital, through effective and the prominent role played by intellectual capital within the economic unity in order to achieve a sustainable competitive advantage contribute to attracting investors with longer investment decision of the most important and difficult decisions ta

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Publication Date
Sun Jun 30 2013
Journal Name
College Of Islamic Sciences
 Quranic ills of the use of the heat (d. 637 AH)
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Praise be to the one who taught the pen. Without the pen, the knowledge of the first two would not have reached the others. Then, praise the one who taught man from the printing industry unless he knew, and prayers and peace be upon those who guide all nations to the invention and the follower in the matter of religion, and to his family and companions.
      The use of Qur’anic use is an integrated and important topic that examines the building and the meaning, which are two major titles in the study of Arabic, so the goal of scholars when going into these explanations was to find out the wonderful linguistic miracle of this great book.
     Scholars have worked hard to talk

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Publication Date
Tue May 30 2023
Journal Name
Basrah Arts Journal
The impact of Mesopotamian myths on the drawings of Al-Wasiti
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Al-Wasiti's drawings are the first attempt to document the Arab landscape more than 778 years ago. These drawings were associated with a fine literary material, and the relationships between words and poetic sentences are matched by artistic, aesthetic and color relations in drawing, as they are all outputs of a sense that agreed in creativity and differed in the language of expression. Al-Wasiti was creative in drawing these events. Islamic painting has a goal that differs from the goals of the painting arts that preceded it or its contemporary, as it tends to “beautification” only. This is achieved by true copying from nature, just as it is achieved by drawing what is transmitted from nature, transforming and refining it. The

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Publication Date
Tue May 23 2023
Journal Name
Journal Of Engineering
Enhancement of the Detection of the TCP SYN Flooding (DDoS) Attack
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The major of DDoS attacks use TCP protocol and the TCP SYN flooding attack is the most common one among them. The SYN Cookie mechanism is used to defend against the TCP SYN flooding attack. It is an effective defense, but it has a disadvantage of high calculations and it doesn’t differentiate spoofed packets from legitimate packets. Therefore, filtering the spoofed packet can effectively enhance the SYN Cookie activity. Hop Count Filtering (HCF) is another mechanism used at the server side to filter spoofed packets. This mechanism has a drawback of being not a perfect and final solution in defending against the TCP SYN flooding attack. An enhanced mechanism of Integrating and combining the SYN Cookie with Hop Count Filtering (HCF) mech

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Publication Date
Mon Sep 30 2024
Journal Name
South Eastern European Journal Of Public Health
Antimicrobial Efficacy of a Novel Herbal Endodontic Irrigant Against Enterococcus Faecalis in Root Canals of Permanent Teeth: An in Vitro Study
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Background: A successful endodontic treatment is aimed at the sterilization of the entire pulp space. The use of extracts from Rhamnus prinoides as a novel irrigating material for root canal has not been studied . Hence, the antimicrobial efficacy of the alcoholic extract of Rhamnus prinoides as an irrigation material against E. faecalis was evaluated in comparison with the 2.5% sodium hypochlorite (NaOCL) solution used for root canals of permanent teeth. Methods: A total of 30 single-rooted human permanent teeth were thoroughly cleaned, shaped, and disinfected. Then, each tooth was subjected to a two-week infection with Enterococcus faecalis at 37 °C . Afterward, the samples were divided into three groups (10 teeth per group): 0.9

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Publication Date
Mon Sep 01 2014
Journal Name
Journal Of Accounting And Financial Studies ( Jafs )
Forensic accounting role in governance and its impact on the quality of accounting information
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That the structural changes in the environment, business and finance and the spread of business and the diversity of transactions between economic organizations and breadth of a commercial scale in the world have left their clear on the need to keep up with the accounting for these variables as one of the social sciences affect and are affected by the surrounding environment because of the various economic and social factors, technical, legal and others.

As a result of these variables emerged a new field of accounting called Forensic Accounting, which involves the use of expertise of multiple pour in the end to the accounting profession, where the Forensic Accounting cover a large area of ​​disciplines including strengthening

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Publication Date
Fri Sep 15 2023
Journal Name
History Of Medicine
The multifaceted role of Dectin-1 and Card9 in inflammatory bowel disease Iraqi patients
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The study aimed to investigate the role of Dectin-1 and Card-9 in pathogenicity of inflammatory bowel disease (IBD). This investigations involved 150 blood samples for IBD patients which divided in to two groups (50 for crohns disease CD (G2) and 50 for ulcerative colitis UC (G3)). All a apparently (male and female) attended to) Al-Kindy hospital) in Baghdad city, department of Gastroenterology. and all of thin were diagnosis by consulters medical staff and pathologists with age range 15-65years average 40 years. in addition to 50 blood samples were collected from apparently healthy individuals as control group (G1). 10 ml were withdrawn from all participants, 5ml for the immunological study which carried by ELISA technique and 5 ml used fo

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Publication Date
Wed Feb 05 2020
Journal Name
Journal Of Physical Education
The Effect of Group Investigation Model on Learning overhead and underarm Pass in Volleyball
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Volleyball is one of the sports that require physical and skill abilities thus many teaching models appeared to teach these abilities like group investigation model. The research aimed at identifying the effect of group investigation model on learning underarm and overhead passing in volleyball. The researchers hypothesized statistical differences between pre and posttests in learning underarm and overhead passing in volleyball as well as differences in posttests of controlling and experimental groups in learning underarm and overhead passing in volleyball. The researcher used the experimental method on (30) second year female students of physical education and sport sciences college/ university of Baghdad. Group investigation model was app

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Publication Date
Wed Jan 01 2025
Journal Name
Journal Of Advanced Pharmacy Education And Research
Ultra HPLC method development and validation for the determination of meclizine in pharmaceutical formulation
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Publication Date
Wed Mar 18 2020
Journal Name
International Journal Of Research In Social Sciences And Humanities
THE DILEMMA AND RESISTANCE OF SALMA IN FADIA FAQIRA NOVEL MY NAME IS SALMA
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