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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
Mon Jun 19 2023
Journal Name
Journal Of Engineering
The Effect of Services system in Architectural form developments
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Architecture forms theoretical summaries and multi systems that have the essence of change, and that what distinguishes Architecture from other sciences and their systems. Architecture means way of life via its expressional products and that appears through its systems. These systems are based on formative and technological properties in form, structure, services and materials as well as
their moral forms. All these are associated with techniques and facilities in order to establish integrated system.
Architectural creation does not come from void but it depends on a conception base to create a new condition for creative architectural product. The general problem of the research concentrated on limited theoretical and practica

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Publication Date
Tue Oct 23 2018
Journal Name
Journal Of Economics And Administrative Sciences
Comparison Bayes Estimators of Reliability in the Exponential Distribution
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Abstract

           We produced a study in Estimation for Reliability of the Exponential distribution based on the Bayesian approach. These estimates are derived using Bayesian approaches. In the Bayesian approach, the parameter of the Exponential distribution is assumed to be random variable .we derived bayes estimators of reliability under four types when the prior distribution for the scale parameter of the Exponential distribution is: Inverse Chi-squar

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Publication Date
Sat Dec 11 2021
Journal Name
Engineering, Technology & Applied Science Research
The Influence of Base Layer Thickness in Flexible Pavements
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Flexible pavement design and analysis were carried out in the past with semi-experimental methods, using elastic characteristics of pavement layers. Due to the complex interferences between various layers and their time consumption, the traditional pavement analysis, and design methods were replaced with fast and powerful methods including the Finite Element Method (FEM) and the Discrete Element Method (DEM). FEM requires less computational power and is more appropriate for continuous environments. In this study, flexible pavement consisting of 5 layers (surface, binder, base, subbase, and subgrade) had been analyzed using FEM. The ABAQUS (6.14-2) software had been utilized to investigate the influence of the base layer depth on ver

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Publication Date
Wed Nov 22 2017
Journal Name
Environmental Toxicology And Chemistry
Factors affecting the dissipation of pharmaceuticals in freshwater sediments
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Abstract<sec><label></label><p>Degradation is one of the key processes governing the impact of pharmaceuticals in the aquatic environment. Most studies on the degradation of pharmaceuticals have focused on soil and sludge, with fewer exploring persistence in aquatic sediments. We investigated the dissipation of 6 pharmaceuticals from different therapeutic classes in a range of sediment types. Dissipation of each pharmaceutical was found to follow first‐order exponential decay. Half‐lives in the sediments ranged from 9.5 (atenolol) to 78.8 (amitriptyline) d. Under sterile conditions, the persistence of pharmaceuticals was considerably longer. Stepwise multiple linear regression analysis was performed to </p></sec> ... Show More
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Publication Date
Fri Dec 16 2022
Journal Name
Journal Of The College Of Languages (jcl)
MCD (LOS MARCADORES DISCURSIVOS) The pragmatic analysis of discourse markers (The argumentative texts of the ABC newspaper as a model): El análisis pragmático de los marcadores discursivos (Los textos argumentativos del periódico ABC como modelo)
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When writing a text, such as a newspaper article, various types of discourse markers are frequently used to group sentences into paragraphs and parts in order to establish a discourse with certain functions, such as coordination, orientation, emphasizing the concepts presented, etc. It should also be noted that this type of mark exists in both written and spoken language. Therefore, it is convenient to dedicate a chapter to these linguistic elements to clarify their use and their classification, which is mainly based on Jose Portolés (2001), as well as the main features, specifically their features (prosodic, morphological, semantic and pragmatic).

Resumen

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Publication Date
Wed Feb 01 2017
Journal Name
Journal Of Economics And Administrative Sciences
Using Fuzzy Games Theory to Determine the optimal Strategy for The Mobile Phone Networks in The Baghdad And Basra governorates
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      The objective of this research is employ the special cases of  function  trapezoid in the composition of fuzzy sets to make decision within the framework of the theory of games traditional to determine the best strategy for the mobile phone networks in the province of  Baghdad and Basra, has been the adoption of different periods of the  functions belonging to see the change happening in the matrix matches and the impact  that the strategies  and decision-making  available to each player and the impact on  societ

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Publication Date
Sun Mar 15 2020
Journal Name
Al-academy
Deconstruction and the Acting Performance for the Shakespearean Character in the Iraqi Theatre: هيثم عبد الرزاق علي-اياد طارش ساجت
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Researchers classified deconstruction as a strategy concerned with reading the philosophical, literary, artistic and critical texts according to (construction and deconstruction) binarism, which is an applied procedural space that calls for researching the layers of meaning and its non-closure. It establishes reversals in the text level.  The center changes into a margin and vice versa.  Thus the two researchers sought to study the deconstruction strategy and its work in the theatre field, that deconstruction is considered one of the most important modern currents  that actively inters in reading the theatre show.  The research studies the procedure of the construction and deconstruction of the Iraqi theatre actor reg

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Publication Date
Thu Dec 30 2021
Journal Name
Diyala Agricultural Sciences Journal
A Study of Some Biological Aspects of Pacu Piaractus Brachypomus (G. Cuvier, 1818)
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The present study attempts to shed light on some biological aspects and characteristics of Piaractus brachypomus, including some biometrics, phenotypic and feeding pattern that characterizes this species. Besides, the study touches upon the body shape and the Otolith. These fish species have recently been seen frozen in the Iraqi local market. The standard length of fish specimens in this study reach 26.55cm it exceeded the specimens of Pacu fish collected from other studies from other countries, As well the specimens weight was 632gm it exceeded other studies mentioned in this manuscript. As the irregularity in the distribution of teeth rows, especially in the lower jaw was clear in our specimens. The average weight of some skull b

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Publication Date
Wed Mar 15 2023
Journal Name
Journal Of Petroleum Research And Studies
A Numerical Study of Tertiary Oil Recovery by Injection of Low-Salinity Water
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The injection of Low Salinity Water (LSWI) as an Enhanced Oil Recovery (EOR) method has recently attracted a lot of attention. Extensive research has been conducted to investigate and identify the positive effects of LSWI on oil recovery. In order to demonstrate the impact of introducing low salinity water into a reservoir, simulations on the ECLIPSE 100 simulator are being done in this work. To simulate an actual reservoir, an easy static model was made. In order to replicate the effects of injecting low salinity water and normal salinity, or seawater, the reservoir is three-phase with oil, gas, and water. It has one injector and one producer. Five cases were suggested to investigate the effect of low salinity water injection with differen

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Publication Date
Fri Jun 30 2023
Journal Name
نسق
The Effect of the Needham model in teaching chemistry on interactive thinking among fifth-grade scientific students in Iraq
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