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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 Feb 02 2012
Journal Name
Education College Journal/al-mustansiriyah University
On Significance Testimator in Pareto Distribution Via Shrinkage Technique
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In this paper, preliminary test Shrinkage estimator have been considered for estimating the shape parameter α of pareto distribution when the scale parameter equal to the smallest loss and when a prior estimate α0 of α is available as initial value from the past experiences or from quaintance cases. The proposed estimator is shown to have a smaller mean squared error in a region around α0 when comparison with usual and existing estimators.

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Publication Date
Sun Oct 31 2021
Journal Name
Periodicals Of Engineering And Natural Sciences (pen)
Image segmentation by using thresholding technique in two stages
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Image segmentation can be defined as a cutting or segmenting process of the digital image into many useful points which are called segmentation, that includes image elements contribute with certain attributes different form Pixel that constitute other parts. Two phases were followed in image processing by the researcher in this paper. At the beginning, pre-processing image on images was made before the segmentation process through statistical confidence intervals that can be used for estimate of unknown remarks suggested by Acho & Buenestado in 2018. Then, the second phase includes image segmentation process by using "Bernsen's Thresholding Technique" in the first phase. The researcher drew a conclusion that in case of utilizing

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Publication Date
Mon Feb 13 2023
Journal Name
Journal Of Educational And Psychological Researches
Challenges Facing Blended Education from the Point Of View of Teachers Teaching Children with Disabilities
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The current research aims to identify: 1) the challenges facing blended education from the point of view of teachers of students with disabilities. 2) The challenges facing blended education from the point of view of teachers of students with disabilities according to the gender variable (males-females). 3) The challenges facing blended education from the point of view of teachers of students with disabilities, according to the academic qualifications of graduates

(institute-bachelors-masters). 4) The challenges facing blended education from the point of view of male and female teachers, according to the functional service period with students with disabilities (less than 8 years - from 9 to 15 years - 16 years and above). 5) the

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Publication Date
Mon Jun 19 2023
Journal Name
Journal Of Engineering
REVIEW THE ASSESSMENT OF EFFECTS OF LOST TIME INJURIES IN AN INDUSTRIAL SYSTEM BY USING AN EXPLANATORY PROGRAM
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Health and safety problem can be described by statistics it can only be understood by knowing and feeling the pain, suffering, and depression. Health and safety has a legal responsibility to protect it for everyone who can affect in the workplace. This includes manufacturers, suppliers, designers and controllers of work places and employees. Work injury is one of the major problems in manufacturing and production systems industries; it is reduced production efficiency and affects the cost. To gain flexibility from a traditional manufacturing system and production efficiency, this paper is about the application of estimating technology to preview and synthesis of Lost Time of Work Injuries in industry systems aims to provide a safe workin

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Publication Date
Fri Dec 30 2022
Journal Name
Journal Of The College Of Education For Women
Military Arrangements for the Battle of Kadesh in 1274 BC During the Era of the New Kingdom
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The Battle of Kadesh is replete with many military arrangements that reflect the tremendous development of war preparations in the thirteenth century BC; where the expressive pictures the Egyptians left on some of the walls of their temples show the tremendous ability to organize and divide the forces and the great development that affected the war machine. Furthermore, the text accompanied these pictures reveal some news about that battle, which is considered one of the most important wars in the ancient world. Thus, the importance of the study lies in the fact that it examines one of the most important battles of the ancient Near East, the results of which had great repercussions on the region. This is because it is the most abundant B

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Publication Date
Fri Dec 31 2021
Journal Name
Iraqi Journal Of Market Research And Consumer Protection
GEOMETRY OPTIMIZATION OF COUPLING ALLIN -METFORMIN USING DFT/B3LYP MOLECULAR MODELLING TECHNIQUE: GEOMETRY OPTIMIZATION OF COUPLING ALLIN -METFORMIN USING DFT/B3LYP MOLECULAR MODELLING TECHNIQUE
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This researchpaper includes the incorporation of Alliin at various energy levels and angles 

With Metformin using Gaussian 09 and Gaussian view 06. Two computers were used in this work. Samples were generated to draw, integrate, simulate and measure the value of the potential energy surface by means of which the lowest energy value was (-1227.408au). The best correlation compound was achieved between Alliin and Metformin through the low energy values where the best place for metformin to b

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Publication Date
Wed Aug 01 2018
Journal Name
European Journal Of Pharmaceutical Sciences
The effect of size and polymer architecture of doxorubicin–poly(ethylene) glycol conjugate nanocarriers on breast duct retention, potency and toxicity
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Publication Date
Thu Nov 01 2018
Journal Name
Journal Of Economics And Administrative Sciences
Analysis of the relationship between the prices of wheat and rice importer in Iraq and crude oil prices and the exchange rate using the ARDL model
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Since the beginning of 21st century, the prices of Agricultural crops have increased. This Increases is accompanied with that increases of crude oil prices and fluctuation of a dollar exchange rate as a dominant currency used in the global trade. The paper aimed to analysis the short run and long run cointegration relationships between prices of some of Agricultural crops imported by Iraq such as wheat and rice crops and both the crude oil prices and the Iraq dinar exchange rate a gained America dollar using ARDL model. The results show the long run equilibrium between they three variable throng the error correction mechanizem. The results also show the significant and economically sound effects of cru

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Publication Date
Wed Oct 05 2016
Journal Name
Al-academy
Dialectical relationship between digital Technique and aesthetic Picture TV
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The technical development has significant effects on the mediator Alcinmatugrave, and TV originated mainly based on technical, with the development and the continuation of these technologies and the enormous impact on the level of the television picture, initially dramas in recent times approaching in the aesthetic composition of the film thanks to the employment of modern digital technologies, Montag was not only one of the cinematic elements that went into television thanks to technical developments analogue and digital, and which added the possibility of large processors in the picture, high-definition digital cameras that have led to dispense often for artificial lighting intensive imaging light available, as these cameras have helpe

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Publication Date
Tue Jan 06 2004
Journal Name
Iraqi Journal Of Science
Cluster and factor analyses R and Q mode technique of geochemical and petrological data of the Shalair Metamorphic Rock Group, Shalair Valley area, Northeastern Iraq
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