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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 Jan 01 2024
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Lecture Notes In Electrical Engineering
A Study of the Influence of Steel Brushes in Rail Surface Magnetic Flux Leakage Detection Using Finite Elements Simulation
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Sun Feb 10 2019
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Journal Of The College Of Education For Women
The Meanings Mentioned in the Quran - objective study
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Praise be to God, who has seen uniting the wonders of manufactures, and pronounced Pthamidh oddity Alambdoat, and swam his creation in different languages, Glory is not equal to one in the earth and the heavens, praise Him, and I bear witness that there is no god but Allah alone with no partner certificate towering branches, and I bear witness that Muhammad is His slave and Messenger sent swage Arab government balance, and clearest statement, and the highest residence and Ohllagha words, and Oovaha Zmama, he pointed the way and advised the creation, and the month of Islam, breaking idols, and showed provisions, uncle Balanaam, God separated blessings and peace upon our Prophet Muhammad and the God of the good and virtuous and his compani

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Mon Dec 18 2017
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Al-khwarizmi Engineering Journal
Prediction of Surface Roughness and Material Removal Rate in Electrochemical Machining Using Taguchi Method
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MORPHOLOGICAL STUDY OF THE TONGUE IN MONGOOSE (HERPESTES JAVANICUS)
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The aim of the current study is to identify the morphological description of the tongue in mongoose (Herpestes javanicus) and its relation to the feeding pattern. For this purpose the (5) samples of tongues were dissected from the head of mongoosecaught from different areas of Al-Najaf province, cleaned in normal saline and examined under the dissecting microscope. The results showed the absence of the middle groove in the lingual apex area. As well as the absence of lingual prominence in the body area. The dorsal surface is characterized by the presence of four types from lingual papillae (filiform, cylindrical, fungiform, circumvallate), while the ventral surface is free of lingual papillae. The filiform papillae spread throughout the dor

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Tue Mar 03 2026
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The school system and its relationship to the evolution of some indicators of physical and functional skills in a lesson and basketball
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Effect of Rehabilitation Program by Using Hypermedia on Treatment Some of Shoulder Tissues Injuries for Badminton Players
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