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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
Sat Jun 01 2013
Journal Name
Journal Of The College Of Languages (jcl)
Violation of the Strategies of Conversation in Some English Selected Plays
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The present study analyzes the violation of the strategies of conversation in two English plays namely Richard II and King Lear. The present study tries to achieve the following goals: 1. showing how the strategies of real conversation can be applied to conversation in plays. 2. analyzing how the characters communicate with each other to discover how Shakespeare violates the strategies of conversation in depicting his characters. The study has been conducted on the bases of the following hypotheses:

  1. The strategies of conversation which are derived from the study of natural conversation can be applied to conversation in drama with some modification for dramatic purposes.

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Publication Date
Wed Jan 01 2020
Journal Name
Route Educational And Social Science Journal
SURVIVAL IN TIMES OF PANDEMICS: THE PROPHETIC VISION OF JACK LONDON
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Publication Date
Sun Dec 02 2018
Journal Name
Journal Of The College Of Education For Women
The Level of Career Involvement of Primary School Managers in Baghdad
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The study aimed to identify career engagement among school principals, the researcher used descriptive approach and reached the study sample (230) school, principals. The researcher instruments used: career engagement, has been checked and face validity, and construction and consistency of the instruments using internal consistency Cronbach's alpha The study came to the following findings: - The degree of career engagement among school principals was (29.0200) this refers to a higher level, compared with the theoretical average of (27) and the study showed that the results showed no significant statistical differences between school principals in the level of career engagement due to the variable sex.

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Publication Date
Wed Mar 29 2023
Journal Name
Journal Of The College Of Education For Women
Geographical Analysis of Sanitation Workers in the Urban District of Kut
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Cleaning is one of the services provided by the state and its ad hoc institutions. Every developed country is clean due to the good planning and attention given to the staff of all municipalities and service institutions. Beside, the attention paid to this sector is considered one of the windows to maintain the states’ aesthetics. If janirtos stop disposing of all the discarded wastes, the result will be having big piles of waste, affecting accordingly the health and safety of its citizens and the aesthetics of the areas. The janitors and those responsible for them are tha staff that the state must take care of because of their importance to the state in general and to the province in particular. The importance of the research

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Publication Date
Mon May 01 2017
Journal Name
2017 5th International Conference On Information And Communication Technology (icoic7)
Analysis of the number of ants in ant colony system algorithm
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Publication Date
Sun May 10 2020
Journal Name
Baghdad Science Journal
In Silico Analysis of Regulatory Elements of the Vitamin D Receptor
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Vitamin D receptor (VDR) is a nuclear transcription factor that controls gene expression. Its impaired expression was found to be related to different diseases. VDR also acts as a regulator of different pathways including differentiation, inflammation, calcium and phosphate absorption, etc. but there is no sufficient knowledge about the regulation of the gene itself. Therefore, a better understanding of the genetic and epigenetic factors regulating the VDR may facilitate the improvement of strategies for the prevention and treatment of diseases associated with dysregulation of VDR. In the present investigation, a set of databases and methods were used to identify putative functional elements in the VDR locus. Histone modifications, CpG I

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Publication Date
Wed May 18 2016
Journal Name
Al-academy
Representations of women in the subject of freedom: سهاد حسن مانع
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Artist kicks off in his production through creative artistic assimilation to the production of concepts and experiences, which can decode the artist blades through the re-built and converted to the subject of my mind according to the processes of analysis and synthesis. Artist need the expertise and experience to complete the technical work, and to develop taste aesthetic, and achieve certain goals belonging to Resume artist, diversity of artistic experiences between mechanism represents a female form and expression of contents and visions that carry letters of freedom in accordance with the creative visual surfaces embody the image of women, the main speeches adopted by propositions technical artists, and artists who relied female form

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Publication Date
Wed Sep 02 2015
Journal Name
Lap Lambert Academic Publishing
The role of tibialis posterior transfer in correction of foot drop
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Publication Date
Tue Feb 05 2019
Journal Name
Journal Of The College Of Education For Women
Directorates of the Ministry of Agrarian Reform Iraq in 1958 - 1968
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After the issuance of agrarian reform first law of 1958 events social economic
accelerating out of sync with political events on the application of the agrarian reform law
issued a government executive branch law number (74) in May 1959 was the introduction of
the ministry of Agrarian reform and the development of a new system of the ministry of
agrarian reform and its department to determine structural ministry the new work started
department of the ministry ptt.

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Publication Date
Mon Oct 01 2018
Journal Name
Journal Of Educational And Psychological Researches
Measuring Gratitude of the Sample of Displaced people in Baghdad city
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Displacement is a problem that worries the human conscience and has received the attention of the international community. Furthermore, it has become one of the most urgent issues nowadays, especially when the number of displaced people in different countries are increased because of the causes of displacement and their political, economic, environmental, social and psychological effects. Iraq is one of the countries where displacement has taken place in several governorates, according to United Nations and International Organization for Migration (IOM), Iraq is considered the second largest country in the world after Syria in terms of the number of displaced people in 2015. Gratitude, a positive emotional response to benevolence, is a m

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