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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
Thu Dec 25 2025
Journal Name
Al–bahith Al–a'alami
THE CULTURAL FACTORS THAT ARE AFFECTING THE COMMUNICATOR IN INTERNATIONAL PUBLIC RELATIONS: ) Reading In Light Of The Theory Of The Cultural Relativism(
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This research addressed the cultural factors that are affecting the communicator in international public relations in light of the theory of the cultural relativism. The research aimed to find out the nature of cultural differences between societies and how can for professionals in international public relations understanding the culture of other and communicate with him peacefully. The researcher used qualitative and interpretative methodology. Some of the important results of the research are: The Communities are affected by cultural factors that are composed from values, customs, traditions, prevailing and inherited ethic, languages, religious beliefs, fashion, gender, colors indi

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Publication Date
Fri Jun 01 2018
Journal Name
Journal Of Physics: Conference Series
Hiding text in gray image using mapping technique
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Publication Date
Sun Jan 01 2023
Journal Name
Journal Of Engineering
Risk Assessment in BOT Contracts using AHP Technique
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The process of risk assessment in the build-operate transfer (BOT) project is very important to identify and analyze the risks in order to make the appropriate decision to respond to them. In this paper, AHP Technique was used to make the appropriate decision regarding response to the most prominent risks that were generated in BOT projects, which includes a comparison between the criteria for each risk as well as the available alternatives and by mathematical methods using matrices to reach an appropriate decision to respond to each risk.Ten common risks in BOT contracts are adopted for analysis in this paper, which is grouped into six main risk headings.The procedures followed in this paper are the questionnaire method

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Publication Date
Tue May 16 2023
Journal Name
Journal Of Engineering
Experimental Investigation Utilizing Thermal Image Technique to the Heat Transfer Enhancement Using Oscillated Fins
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Heat transfer around a flat plate fin integrated with piezoelectric actuator used as oscillated fin in laminar flow has been studied experimentally utilizing thermal image camera. This study is performed
for fixed and oscillated single and triple fins. Different substrate-fin models have been tested, using fins of (35mm and 50mm) height, two sets of triple fins of (3mm and 6mm) spacing and three frequencies
applied to piezoelectric actuator (5, 30 and 50HZ). All tests are carried out for (0.5 m/s and 3m/s) in subsonic open type wind tunnel to evaluate temperature distribution, local and average Nusselt number (Nu) along the fin. It is observed, that the heat transfer enhancement with oscillation is significant compared to without o

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Publication Date
Tue Jun 30 2020
Journal Name
Iraqi Journal Of Market Research And Consumer Protection
STUDY OF SOME IMMUNOLOGICAL PARAMETERS IN PATIENT THAT INFUCTED WITH Streptococcus pyogenes: STUDY OF SOME IMMUNOLOGICAL PARAMETERS IN PATIENT THAT INFUCTED WITH Streptococcus pyogenes
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A streptococci has recognized as Streptococcus spp., associate with acute pharyngitis. S. pyogenes infection Has detected in the Hospital and Health Center in Tikrit city. Throat swabs sample has obtained and cultured on a sheep blood agar plate. Identification of S. pyogenes was performed by using the VITEK 2 automatic system. It detected of 50 samples from children included 25 were positive for S. pyogenes infection. were aged 10-35 years old and included 30 male and 20 female. . While 25 sample Negative of S. pyogenes infection (The control group included 25 clinically healthy children without S. pyogenes infection matched for age and sex with cases pateints). No significa

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Publication Date
Wed Jun 01 2022
Journal Name
Political Sciences Journal
Political Transformations in The Republic of Turkmenistan During the Period (1991-2021)
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After the fall of the Soviet Union, a number of Eastern Bloc countries and Soviet republics have witnessed political transition. However, Turkmenistan, as one of the former Soviet republics, succeeded to preserve the authoritarian nature of the former Soviet regime. This study seeks to answer a number of research questions, the most prominent of which are: How were the political elite in Turkmenistan able to preserve the legacy of the Soviet policy based on centralization of power and individual rule?. The study reaches a set of conclusions, the most important of which are:

1-The roots of the tyranny in Turkmenistan are du to internal and external structural factors. The most important of which are: the former Soviet policies of m

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Publication Date
Tue Feb 01 2022
Journal Name
Journal Of Engineering
Self-Repairing Technique Based on Microcapsules for Cementitious Composites- A Review
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Self-repairing technology based on micro-capsules is an efficient solution for repairing cracked cementitious composites. Self-repairing based on microcapsules begins with the occurrence of cracks and develops by releasing self-repairing factors in the cracks located in concrete. Based on previous comprehensive studies, this paper provides an overview of various repairing factors and investigative methodologies. There has recently been a lack of consensus on the most efficient criteria for assessing self-repairing based on microcapsules and the smart solutions for improving capsule survival ratios during mixing. The most commonly utilized self-repairing efficiency assessment indicators are mechanical resistance and durab

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Publication Date
Wed Mar 16 2022
Journal Name
2022 Muthanna International Conference On Engineering Science And Technology (micest)
A hybrid feature selection technique using chi-square with genetic algorithm
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Publication Date
Mon May 01 2023
Journal Name
Journal Of Engineering
Experimental Investigation of Heat Transfer Enhancement in a Double Pipe Heat Exchanger Using Compound Technique of Transverse Vibration and Inclination Angle
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Numerous tests are recently conducted to assess vibration's role in accelerating the heat transfer rate in various heat exchangers. In this work, the enhancement of heat transfer by the effect of transfer vibration and inclination angles on the surface of a double pipe heat exchanger experimentally has been investigated. A data acquisition system is applied to record the data of temperatures, flow rates, and frequencies over the tests. A compound technique was adopted, including the application of a set of inclination angles of (0°, 10°, 20°, and 30°) under the effect of frequency of vibration ranging from sub-resonance to over-resonance frequencies. The results showed that the overall heat transfer coefficient enhan

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Publication Date
Tue Aug 14 2018
Journal Name
Thesis (phd)
The Role of the Deubiquitylase MYSM1 During Alphavirus Infection
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The Role of the Deubiquitylase MYSM1 During Alphavirus Infection Amer Nubgan The members of the genus Alphavirus are positive-sense RNA viruses and it is one of two within the family Togaviridae. Most alphaviruses are predominantly transmitted to susceptible vertebrates by a mosquito vector. Alphavirus disease in humans can be severely debilitating, and depending on the particular viral species, infection may result in encephalitis and possibly life threatening symptoms. Chikungunya virus (CHIKV) is the aetiological agent represents a substantial health burden to affected populations, with clinical symptoms that include severe joint and muscle pain, rashes, and fever, as well as prolonged periods of disability in some patients. In recent

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