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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.

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 Jan 21 2023
Journal Name
Indian Journal Of Health Sciences And Biomedical Research (kleu)
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Publication Date
Tue Apr 01 2014
Journal Name
Journal Of Economics And Administrative Sciences
Analsis of politic behavior and its impact on displaying the continuousness of organizational trust mantainance ,applied research of a sample of AL-farouq State Construction contracting company Employees

The research aims to know the concept of politic behavior as one of the important behaviours in the different fields and sectors. It is considered to be part of the organizatial work to face the expected  risks. It includes two group of factors personal (self –monitors, locus of control ,expectation s of success, perceived job alternatives)and organizational(promotion ,division resources,role  ambiguity ,democratic decision)studied by the researcher  in the frame of the relationship with the variable  of display  continuous trust matain which includes two variable (build trust mantain, display  trust continuouness)through applied frame by random sample consists of (90)employee  at Farouq State

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Publication Date
Wed Jan 01 2020
Journal Name
Journal Of Xi'an University Of Architecture & Technology
The Effect of (Landa) Model on Acquiring Grammatical Concepts Upon His Request to the College of Administration and Economics University of Bagdad

The current research aims to identify the impact of the (Landa) model on acquiring grammatical concepts among students of the College of Administration and Economics, University of Baghdad, and to achieve the research goal, the researcher has set the following hypotheses: There are no statistically significant differences at the level of significance (0.05) between the average degrees Students of the experimental group who studied the Arabic language according to the (Landa) model and the marks of the students of the control group who studied the same subject in the usual way in the post test, there are no statistically significant differences at the level of significance (0.05) in the average differences between the test scores before and

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Publication Date
Thu Dec 31 2020
Journal Name
College Of Islamic Sciences
The cultural identity in the novel "The American Granddaughter" by writer InamKaghi

The identity of the cultural identity of the party (the ego and the other) during a series of questions subject to the transformations of history and the process of culture, the search of identity and its characteristics within the novel discourse calls to address the cultural impact communication discourse aims to reveal the functional and intellectual benefits that contributed to the formation of cultural identity, and stand at the most important manifestations And the secretions that mimic a world remains part of it present in the imagination of the producer of the text is moving in accordance with the holistic perception of the world embedded between the lines of the trial.The question of identity as an intellectual dimension in orde

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Publication Date
Wed Nov 20 2024
Journal Name
Journal Of Baghdad College Of Dentistry
The Clinical Approach and Treatment of Benign and Malignant Parotid Masses

Background: Parotid gland tumors account for 80% of all salivary gland neoplasms, 20% of these are malignant, but in daily clinical practice most parotid masses are operated on before obtaining the final histological diagnosis. This clinical setting further complicates the critical point of parotid surgery, which is the management of the facial nerve. Materials and methods: 45 patients underwent parotidectomy for benign and malignant neoplasms. A complete history is collected from the patients with the duration and the site of the tumor, the facial nerve examined and its associations, a medical consultation done for opinion and management. Clinical examination with facial nerve was mandatory to avoid any mistakes that may occur. The most si

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Publication Date
Wed May 29 2019
Journal Name
Journal Of Legal Sciences
What are the principles of legitimacy and licitly and their resources

One of the priorities of having a constitutional life is the establishment of a state of law. This is what gives the constitution credibility and realism, and gives the constitutional judiciary a real ability to perform its function in ensuring respect for the constitution and not exceeding it. Therefore, every state should strive to achieve its legality. A number of principles, principles and rules, including the commitment to the principles of legality and legitimacy, and the first concerns the public bodies in terms of composition and terms of reference, with respect to the second work issued by, and each of The two elements of its existence depends on them, and the sources of both principles must be derived and then stop them, and al

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Publication Date
Wed May 02 2012
Journal Name
Journal Of Planner And Development
the planning and design characteristics of Iraqs mud building and settlement

The Mesopotamian soil is muddy and fertile, and so from ancient eras Iraqis used mud in their building, settlements and architecture in different methodologies according to the nature and the function of the building that was either in its pure form or by mixing it with other materials such as straw . also as raw bricks in different ways either for the whale building or parts of it, or for the finishing parts such as roofing for instance. In this research these different forms and methodologies will permeate through out a chosen examples of historical building, rural buildings and settlements and ancient buildings as well as some current uses of mud in the structures and building in standing cities, this in order to conclude some

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Publication Date
Sun Sep 30 2012
Journal Name
College Of Islamic Sciences
Grammar Lesson in  The Book of Al-Zahir in My Meanings         Words of the people to Abu Bakr al-Anbari (d. 328 AH

Praise be to God, Lord of the worlds, and peace and blessings be upon our master Muhammad, and upon his family and companions as a whole. Now, the research deals with the grammatical issues mentioned in the Book of Al-Zahir in the meanings of people's words to Abu Bakr Al-Anbari (d. 328 AH). Two parts of the book have more than one edition, it was printed by the Iraqi Ministry of Culture and Information Beirut in 1979 AD, and the Al-Resala Foundation issued the second edition in 1992 AD The third edition was printed in Dar Al-Bashaer in Damascus in the year 2003 AD and it was the reliance on the research and the grammatical issues were arranged on topics that are: interrogation - Deletion, exclusion, marbling, call and Wallace Relief and

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Publication Date
Tue Jun 03 2014
Journal Name
Heat Transfer - Asian Research
Publication Date
Thu Dec 17 2020
Journal Name
International Journal Of Molecular Sciences
AhR Activation Leads to Alterations in the Gut Microbiome with Consequent Effect on Induction of Myeloid Derived Suppressor Cells in a CXCR2-Dependent Manner

Aryl hydrocarbon receptor (AhR) is a ligand-activated transcription factor and 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) is a potent ligand for AhR and a known carcinogen. While AhR activation by TCDD leads to significant immunosuppression, how this translates into carcinogenic signal is unclear. Recently, we demonstrated that activation of AhR by TCDD in naïve C57BL6 mice leads to massive induction of myeloid derived-suppressor cells (MDSCs). In the current study, we investigated the role of the gut microbiota in TCDD-mediated MDSC induction. TCDD caused significant alterations in the gut microbiome, such as increases in Prevotella and Lactobacillus, while decreasing Sutterella and Bacteroides. Fecal transplants from TCDD-treated

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