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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 2018
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Opcion
Fast-slow thinking and its relationship to cognitive failure At university students
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Fri Jul 01 2016
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Composite Structures
Bond behaviour between CFRP laminates and steel members under different loading rates
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Carbon fibre reinforced polymers are widely used to strengthen steel structural elements. These structural elements are normally subjected to static, dynamic and fatigue loadings during their life-time. A number of studies have focused on the characteristics of CFRP sheets bonded to steel members under static, dynamic and fatigue loadings. However, there is a gap in understanding the bonding behaviour between CFRP laminates and steel members under impact loading. This paper shows the effect of different load rates from quasi-static to 300 × 103 mm/min on this bond. Two types of CFRP laminate, CFK 150/2000 and CFK 200/2000, were used to strengthen steel joints using Araldite 420 epoxy. The results show a significant bond strength enhancemen

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Publication Date
Sun Dec 30 2018
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Crack Growth Behavior through Wall Pipes under Impact Loading And Moisten Environment
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Publication Date
Thu Dec 01 2022
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Steganography and Cryptography Techniques Based Secure Data Transferring Through Public Network Channel
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Consumer Subjective Values and their Reflection on Fashion Design: وسن خليل إبراهيم
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Fri Dec 01 2017
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Functional Engagement and Its Relationship to Hope-Based Thinking for Kindergarten Teachers
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Publication Date
Thu Feb 16 2017
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Signal, Image And Video Processing
Enhancing Prony’s method by nuclear norm penalization and extension to missing data
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