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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
Sat Dec 15 2018
Journal Name
Journal Of The College Of Education For Women
The Reasons for the Behavior of Bullying school Students in the first grade average from the point of view of teachers and teachers and methods of modification
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 هدف البحث التعرف الى اسباب سلوك التنمر لدى طلاب الصف الاول المتوسط من وجهة نظر المدرسين والمدرسات واساليب تعديله، واستعمل الباحثان المنهج الوصفي واختيار عينة عشوائية من المدرسين والمدرسات في متوسطة أرض الرافدين ومتوسطة الرحمن للبنين وكان عددهم (46) مدرساً ومدرسة بواقع (32) مدرساً و(14) مدرسة، واعتمد الباحثان الاستبانة أداة للتعرف الى اسباب سلوك التنمر واساليب تعديله، واشارت نتائج البحث الى تنوع اسباب التن

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Publication Date
Fri Jul 01 2016
Journal Name
Journal Of Economics And Administrative Sciences
A reflection of organizational citizenship behaviors in the performance of employees A prospective study of a sample of the teaching staff working in the Degla University College
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Abstract
        This research aims to identify the relationship and the impact of the behavior of organizational citizenship in the performance of employees, as practiced behaviors organizational citizenship substantial role in achieving the objectives of both the organization and its staff at the same time, so it affects a large extent on the characteristics and performance of individuals employees and thus influence the success of the organization as a whole, problem of the research has indicated that there is a clear failure in the study of the impact of the behavior of organizational citizenship in the performance of employees, was chosen

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Publication Date
Mon Jan 02 2017
Journal Name
Al-nahrain Journal For Engineering Sciences (njes)
Experimental Investigation of Forced Convection Heat Transfer and Pressure Drop in Open Cell Aluminum Fins
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Publication Date
Sun Oct 01 2017
Journal Name
Journal Of Economics And Administrative Sciences
Mackenzie role model dimensions in the quality of service, "a Prospective study of the views of a sample of Iraqi banks managers
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The organizational integration forms a necessity according to McKinsey model, especially for service organizations. In the context of various service sector developments, importance adoption of compact mechanisms by these organizations to upgrade their services has increased and senior management must be more aware of environmental, competitive and developmental requirements. It gets more important when it shows in an organization seeking at excellence of making services within its policies and strategies. Subject organizational integration dimensions (strategy, structure, systems, style, staff, shared values, and skills) are effective components in directing behaviors of employees and organization. This motivated both researcher

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Publication Date
Wed Jan 02 2019
Journal Name
Journal Of Educational And Psychological Researches
The Effect of Using the Oral Open-Ended Questions on Achievement and Developing Creative Thinking for Third-stage Arabic Department of Education College Students
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The problem of present study is determined by answering the following questions:                                                                   

1) What is the effect of using the oral open- ended questions on Students' achievement in the third-stage of Arabic department in the college of Education? 2) What is the effect of the oral open-ended questions on developing the creative thinking of students in

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Publication Date
Thu Jun 01 2017
Journal Name
International Journal Of Engineering Research And Advanced Technology
The Use of First Order Polynomial with Double Scalar Quantization for Image Compression
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Publication Date
Tue May 01 2012
Journal Name
2012 Second International Conference On Digital Information And Communication Technology And It's Applications (dictap)
The compact Genetic Algorithm for likelihood estimator of first order moving average model
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Recently Genetic Algorithms (GAs) have frequently been used for optimizing the solution of estimation problems. One of the main advantages of using these techniques is that they require no knowledge or gradient information about the response surface. The poor behavior of genetic algorithms in some problems, sometimes attributed to design operators, has led to the development of other types of algorithms. One such class of these algorithms is compact Genetic Algorithm (cGA), it dramatically reduces the number of bits reqyuired to store the poulation and has a faster convergence speed. In this paper compact Genetic Algorithm is used to optimize the maximum likelihood estimator of the first order moving avergae model MA(1). Simulation results

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Publication Date
Thu Nov 01 2012
Journal Name
Journal Of The Saudi Society Of Dermatology & Dermatologic Surgery
Basal cell carcinoma: Topical therapy versus surgical treatment
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KE Sharquie, AA Noaimi, Journal of the Saudi Society of Dermatology & Dermatologic Surgery, 2012 - Cited by 36

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Publication Date
Fri Dec 26 2025
Journal Name
Foro De Profesores De Ele(universitat De València)
Study of the difficulties and strategies of learning atonic pronouns in ELE teaching in Iraq
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The objective of this study is to analyze the difficulties faced by intermediate-level Iraqi students in the use of Spanish unstressed pronouns as a foreign language (ELE). Through a mixed methodology, a descriptive and explanatory analysis was conducted based on written and oral productions of B1-level students at the University of Baghdad.The results show that factors such as interference from the native language (Arabic) and English, as well as grammatical differences between Spanish and Arabic, generate difficulties in the correct use of unstressed pronouns. A contrastive teaching approach is proposed that takes advantage of students' cognitive abilities to highlight similarities and differences between both languages.This stu

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Publication Date
Sat Jul 01 2017
Journal Name
International Journal Of Science And Research (ijsr)
Post Cesarean Section Surgical Site Infection; Incidence and Risk Factors
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The rate of births delivered by cesarean section (CS) has gone up substantially all over the world. Post-cesarean surgical site infection (SSI) is a common cause of maternal morbidity and mortality that results in prolonged period of hospitalization with increased cost and direct health implications, especially in low socioeconomic population, resource- restricted settings, and war- related conditions with internal forced movement. This study was aimed to find incidence of post cesarean section surgical site infection withthe accompanying risk factors.Pregnant ladies admitted to department of obstetrics and gynecology at Medical City Hospital in Baghdad who had undergone CSs were followed up prospectively from first of January 2017 till end

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