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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
Wed Jun 01 2022
Journal Name
Journal Of The College Of Languages (jcl)
A comparative study of the pivotal characters in the novel "Al-Shahz" and the script "Hamoon": بررسی تطبیقی شخصیت¬های محوری در رمان «الشحّاذ» و فیلم‌نامۀ «هامون»
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The novel is the revelation of the attitudes of every age. And the writers do not know the winner of their stroke to express these events، The research has been working on a descriptive-analytical approach based on the American Comparative School، Al-Shahez's novel explores the work of the nobly and the film by Hamoun by Dariush Mehrjui By relying on the main characters of these two narratives, they depict a picture of Egypt and Iran From the symbolic lines of these works. In fact, the authors of this research have tried to initiate the introduction and analysis of these two works In fact, the authors of this research have tried to initiate the introduction and analysis of these two works.

 The results of the research show that

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Publication Date
Mon Dec 18 2017
Journal Name
Agronomy
A Case Study of Potential Reasons of Increased Soil Phosphorus Levels in the Northeast United States
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Recent phosphorus (P) pollution in the United States, mainly in Maine, has raised some severe concerns over the use of P fertilizer application rates in agriculture. Phosphorus is the second most limiting nutrient after nitrogen and has damaging impacts on crop yield if found to be deficient. Therefore, farmers tend to apply more P than is required to satisfy any P loss after its application at planting. Several important questions were raised in this study to improve P efficiency and reduce its pollution. The objective of this study was to find potential reasons for P pollution in water bodies despite a decrease in potato acreage. Historically, the potato was found to be responsible for P water contamination due to its high P sensitivity a

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Publication Date
Sun Mar 02 2014
Journal Name
Baghdad Science Journal
We study the effect of Ultra violet rays (A-B) in treatment of Vitiligo (applied Therapy)
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This research evaluated the effect of (UV)(400-320A)Hz(320-220B)Hz on the patient with vitiligo , using it with our new combing therapy that include the oral (Psorlene ) topical , meladinine solution applied on the Vitiligiousns Lesions , In edition to the instralesnional injection in the Vitiligiousns Lesions by long acting steroid (kenacort-A ) by aprecentage of (5%) , after that we expose the patient to UV . The ruslets of this way of treatment more effective by using of the UV rays in the treatment of vitiligo , while the previous treatment that used the UV ray with or with out the psorlene , the results were not effective on controlling of the Vitiligio diseases comparing by the treatment used in this research as it stop’s the sp

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Publication Date
Sun May 01 2022
Journal Name
Journal Of Engineering
The Collapsible Soil, Types, Mechanism, and identification: A Review Study
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Collapsible soil has a metastable structure that experiences a large reduction in volume or collapse when wetting. The characteristics of collapsible soil contribute to different problems for infrastructures constructed on its such as cracks and excessive settlement found in buildings, railways channels, bridges, and roads. This paper aims to provide an art review on collapse soil behavior all over the world, type of collapse soil, identification of collapse potential, and factors that affect collapsibility soil. As urban grow in several parts of the world, the collapsible soil will have more get to the water. As a result, there will be an increase in the number of wetting collapse problems, so it's very important to com

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Publication Date
Sat Dec 30 2023
Journal Name
Journal Of The College Of Education For Women
The Middle East and Contemporary Geostrategic Shifts: A Geopolitical Study
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This research focuses on the contemporary geostrategic transformations that afflicted the countries of the Middle East, with a focus on the countries of the Arab East, after the collapse of the system of international relations, and the emergence of the unipolar system led by the United States of America. After the events of September 11 and the events that followed, especially the occupation of Iraq in 2003, the study area witnessed a group of geopolitical variables and the emergence of dangerous phenomena that threatened the state structure in the countries of the Middle East; the most notably are the phenomenon of terrorism, cross-border armed groups, sectarian polarization, the phenomenon of migration and the internal and the externa

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Publication Date
Wed Jun 01 2022
Journal Name
Political Sciences Journal
The Middle East and its Strategic Dimensions: a theoretical study
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Characterized the Middle East has geographic, economic, and geostrategic peculiarities, but it suffers from many problems, such as disagreement over what it means as a concept, or what it represents of a geographic extension. The question is related to the ambiguity surrounding the concept of the Middle East? The purpose of its launch? As it relates to its geostrategic, economic, and geo-cultural importance? And manifestations of this importance? And to what extent he retained his value in the strategies of the major powers? Research hypotheses:

-The multiplicity of concepts for the Middle East region, with international political and Geostrategic interests.- The geostrategic value of the Middle East has made it a focal point for

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Publication Date
Wed Mar 30 2022
Journal Name
College Of Islamic Sciences
Discretionary Punishment (Al-Ta'zir) for the Interest and its Effect in Keeping the Public Regulation A Fundamental Applied Study in the Saudi Arabian Courts
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Discretionary Punishment, Public Regulation, Interest

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Publication Date
Tue Jun 30 2015
Journal Name
Al-kindy College Medical Journal
Epidemiological characteristics of acute symptomatic hepatitis A in Al Alwyia pediatric teaching hospital during 2013
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ABSTRACTBackground: Concerns about hepatitis A infections is increasing worldwide specially after improving economic and sanitary conditions in many countries making older age groups who escape infection on early life vulnerable to infection.Objectives: The objectives were to estimate the frequency of hepatitis A among children consulting Al Alwyia pediatric Teaching Hospital during the year 2013 and to study some demographic characteristics of the disease.Methods: This cross - sectional hospital -based study wasconducted during 2013-2014 and include pediatric patients(43525 patients) who consult Al Alwyia pediatric hospitalduring that time. The outcome is total IgM antibodies tohepatitis A virus detected using Enzyme Linked FluorescentA

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Publication Date
Fri Oct 21 2022
Journal Name
International Journal Of Professional Business Review
The Impact of Dumping Policy on the Food Gap of Chicken Meat in Iraq For the Period (2004-2019) - Turkish Imports Of Chicken Meat a Case Study
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Purpose: As a result of the sudden and ill-considered trade openness of Iraq after 2003 to the countries of the world in general and the neighboring countries in particular, and in the absence of the necessary support for the national productive forces and the lack of effective standardization and quality control devices, this led to the exposure of most local products, especially agricultural ones, to decline and inability On the competition and thus dumping the Iraqi market, especially the agricultural products, with imported products, this study came to find out the effect that dumping has on the local production of chicken meat and the impact of that impact on the size of the food gap, and whether the results of the practica

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Publication Date
Sun Jan 01 2023
Journal Name
International Journal Of Economics And Finance Studies
THE ROLE OF TARGET COST MANAGEMENT APPROACH IN REDUCING COSTS FOR THE ACHIEVEMENT OF COMPETITIVE ADVANTAGE AS A MEDIATOR: AN APPLIED STUDY OF THE IRAQI ELECTRICAL INDUSTRY
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