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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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The Act Of An Operator
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In this paper we will study some of the properties of an operator by looking at the associated S-act of this operator, and conversely. We look at some operators, like one to one operators, onto operators. On the other hand, we look at some act theoretic concepts, like faithful acts, finitely generated acts, singular acts, separated acts, torsion free acts and noetherian acts. We try to determine what properties of T make the associated S-act has any of these properties.

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Sat Oct 01 2016
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Journal Of Economics And Administrative Sciences
The economic importance of nanotechnology
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Toady technology Nano since it launched human Alivia third interest and anticipation unusual and that by the decision-makers in the world's governments and its institutions and research departments productivity, especially after the US Congress enact a law (the National Initiative for Tknlojba nanotechnology in the United States of America) and the allocation of large sums of money To support this initiative, the research aims to shed light on the concept of technology nanotechnology, which is technology atheist and the twentieth century, and reflect its economic importance and in order to reach the objectives of the research has been the division of research into several axes has been allocated

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Tue Jun 01 2010
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Assess the level of achievement
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Sun Dec 03 2017
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On the Connection between the Dynamical System and the Ellis Compactification with Transitive Pointed System
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In this paper, some relations between the flows and the Enveloping Semi-group were studied. It allows to associate some properties on the topological compactification to any pointed flows. These relations enable us to study a number of the properties of the principles of flows corresponding with using algebric properties. Also in this paper proofs to some theorems of these relations are given.

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Wed Oct 18 2023
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Objectives: ٨ descriptive study has been conducted in the premature baby unit in Al-Khansaa' and Al-Batool
hospitals for maternity and children in Mosul city to assess knowledge and practice of the nursing staff in the
caring of premature infants. A descriptive study has been conducted in the premature baby unit in Al-Khansaa'
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Mon Sep 30 2019
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College Of Islamic Sciences
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Environment and lifestyle Fish Qattan in the Euphrates River in central Iraq
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Sun Dec 10 2017
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