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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
Thu Dec 05 2019
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Advances In Intelligent Systems And Computing
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Mon May 01 2023
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Kurdish Studies
Establishing Proof Against Those Who Claimed to Contradict Al-Noman in Matters Such as Sales
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Jurisprudential disagreements are a significant source of a vast jurisprudential wealth. Among the manifestations of these disagreements are scholarly critiques raised by some scholars against others, claiming their divergence from the legal evidence or established principles for deducing legal rulings. One such critique is presented by the narrator scholar Abu Bakr Ibn Abi Shaybah, may Allah have mercy on him, directed towards Abu Hanifah al-Nu‘man, may Allah have mercy on him. In his compilation, Ibn Abi Shaybah cited numerous hadiths and traditions that he considered conflicting with the judgments as perceived by Imam Abu Hanifah, may Allah have mercy on him. These issues cover various branches of jurisprudence, including worship, sale

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Publication Date
Wed Aug 01 2018
Journal Name
Journal Of Economics And Administrative Sciences
Proposed Measure for Effect Size in Mediation Analysis with Solution to Some Mediation Process Problems
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In this paper, the effect size measures was discussed, which are useful in many estimation processes for direct effect and its relation with indirect and total effects. In addition, an algorithm to calculate the suggested measure of effect size was suggested that represent the ratio of direct effect to the effect of the estimated parameter using the Regression equation of the dependent variable on the mediator variable without using the independent variable in the model. Where this an algorithm clear the possibility to use this regression equation in Mediation Analysis, where usually used the Mediator and independent variable together when the dependent variable regresses on them. Also this an algorithm to show how effect of the

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Publication Date
Tue Jun 30 2020
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Association Of Arab Universities Journal Of Engineering Sciences
Immiscible CO2-Assisted Gravity Drainage Process for Enhancing Oil Recovery in Bottom Water Drive reservoir
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The CO2-Assisted Gravity Drainage process (GAGD) has been introduced to become one of the mostinfluential process to enhance oil recovery (EOR) methods in both secondary and tertiary recovery through immiscibleand miscible mode. Its advantages came from the ability of this process to provide gravity-stable oil displacement forenhancing oil recovery. Vertical injectors for CO2 gas have been placed at the crest of the pay zone to form a gas capwhich drain the oil towards the horizontal producing oil wells located above the oil-water-contact. The advantage ofhorizontal well is to provide big drainage area and small pressure drawdown due to the long penetration. Manysimulation and physical models of CO2-AGD process have been implemented

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Sun Feb 10 2019
Journal Name
Iraqi National Journal Of Nursing Specialties
Nurses' Practices regarding Patients Discharge Planning post Cardiac Surgery at Cardiac Centers in Baghdad city
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Publication Date
Tue Jun 15 2021
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Sustainability by recycling palm waste in designing women's belts: وفاء حسن شافعي -مرام زيد الحربي
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This research contributes to environmental sustainability by recycling natural waste resources in making clothing products. The research aims to employ palm trees waste in designing belts suitable for contemporary women's fashion trends. Both descriptive and applied research approaches were used. Therefore, a collection of belts was designed and implemented. Then, a questionnaire was used to assess the extent to which the implemented belts achieved in sustainability standards using Likert scale. The sample size was 60 women. The data were analyzed using the SPSS program to calculate the arithmetic mean and standard deviation. One of the significant results of the research is the high average scores of the criteria for achieving sustainab

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Publication Date
Fri Oct 26 2018
Journal Name
Al–bahith Al–a'alami
University youth attitudes towards mobile phone Companies advertisements in Social networking sites): :(Facebook as sample
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The advertising has emerged as an effective force and an effective instrument upon with all organizations and companies depend on achieving their goals. In additional to the need to use promote sales, The nature and objective of advertising go beyond the scope of specific personal communication to a broader and more effective range for consumers from multiple groups and combination play need to use as well as the need to use means of communication than com convey the message more professional, The coincides with the rapid and remarkable development of all different media technologies and as much as possible social networking sites including mobile phone companies. The advertising has emerged as an effective force and an effective instrum

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