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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
Tue Jan 29 2019
Journal Name
Journal Of Accounting And Financial Studies ( Jafs )
The Impact of Tax Laws and Decisions in Determining the Tax Base of the Results of the Financial Statements of Companies
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This research aims to measure the discrepancy between the accounting income which is prepared according to generally accepted accounting principles and the tax income that is being prepared according to the rules and tax laws, and find out the most important differences that arise between incomes.The research found the most important to the following conclusions:1.Faces determining the tax base for companies subject to income challenges related to the weakness of the efficiency and the possibility of technical angel tax and its ability to examine the financial statements submitted to the tax administration tax.2.That the tax system in Iraq does not comply with accepted accounting principles generally accepted.The research recommends the

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Publication Date
Mon Oct 01 2018
Journal Name
Journal Of Economics And Administrative Sciences
The effect of deficiencies in the standards and tools used for the management of the banking system in the emergence of the financial crisis by focusing on the Basel 1and 2
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The banking industry, as a result of the great challenges it faced, required continuous development of the principles of management, control and mechanisms used. The Basel Committee on Banking Supervision has played a leading role in legalizing many of these developments and has been able to contribute significantly to establishing a common framework for banking supervision, The central role in the various countries of the world is based on coordination between the various regulatory authorities and thinking about finding mechanisms to confront the risks faced by banks, recognizing the importance of the banking sector in the stability of domestic and international banking systems or the danger of this sector in the emergence of F

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Publication Date
Tue Aug 24 2021
Journal Name
Agronomy
Impact of Nitrogen Rate in Conventional and Organic Production Systems on Yield and Bread Baking Quality of Soft Red Winter Wheat
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Soft red winter wheat (SRW) is characterized by high yield and relatively low protein content. In Kentucky, there is growing demand from local artisan bread bakers for regionally produced flour, requiring production of grain with increased protein content and/or strength. The objective of this two-year field experiment was to evaluate the effect of nitrogen (N) management on five cultivars of winter wheat on yield and bread baking quality traits of modern and landrace SRW cultivars (Triticum aestivum L.). All five cultivars were evaluated using two N application rates in conventional and organic production systems. All traits measured were significantly affected by the agricultural production system and N rate, although plant height

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Publication Date
Sun Jan 01 2006
Journal Name
Ipmj-iraqi Postgraduate Medical Journal
Elucidation of a role for the aqueous extract of borage in mammary gland growth and development
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Herbal remedies are used in induction of lactation. In view of that .Borage Officinalis was employed to ensure an abundant milk supply or rectify milk insufficiency .However, this remedy has not been scientifically tested .The animals were treated with the aqueous extract of Borage Officinalis flowers at a daily concentration of 100 mg / kg body weight /ml for each rat through Oro-gastric tube for 14 days. Animals were subdivided into subgroups according to their physiological status. Mammary glands of these animals were processed for histological, histochemical and immunohistochemical studies. Parameters indicated that the aqueous extract of Borage Officinalis flowers induced lactogenesis in the mammmary glands of virgin and pregnant rats

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Publication Date
Wed Jan 04 2006
Journal Name
The Iraqi Postgraduate Medical Journal
Elucidation of a Role for the Aqueous Extract of Borage in Mammary Gland Growth and Development
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Publication Date
Thu Mar 01 2018
Journal Name
Ieee Systems Journal
A Comprehensive Survey of the Current Trends and Extensions for the Proxy Mobile IPv6 Protocol
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Publication Date
Thu May 14 2020
Journal Name
Journal Of Planner And Development
Visual Pollution and its Impact on the Aesthetics: The Town of Eizariya as a Model
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This study seeks to shed light on the aspects of visual pollution and its impact on the aesthetics of the town of Al-Eizariya known to suffer from the phenomenon. In order to identify the real causes of the problem which develops in various forms and patterns, threatening not only the aesthetic appearance of the towns, but also causes the emergence of new problems and phenomena that will have negative repercussions on the population. The researcher uses the analytical descriptive method to analyze the phenomenon of visual pollution in terms of reality, development, manifestations and spread and uses photos which document the visual pollution and its impact on the aesthetics of the known. The study concluded the existence of a strong rela

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Publication Date
Mon Feb 04 2019
Journal Name
Journal Of The College Of Education For Women
THE PORTRAIT OF THE ARTIST AS A ROBOT: A LITERARY LOOK AT E-POETRY
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This study examines the validity of e-poetry as an acceptable literary genre. The
thematic, stylistic and esthetic features of a selected number of e-poems produced by
poetry generators are analyzed for this purpose. The e-poems are then compared with a
number of works written by Dada poets in order to establish the literary merit of the
former.

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Publication Date
Sun Oct 06 2024
Journal Name
مؤسسة دار الصادق الثقافية
The vision of the Holy Qur’an in addressing (homosexuality) and the responsibility of those concerned
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Homosexuality is one of the important topics that have emerged in recent times in the Islamic and Arab world, as the topic was in the past one of the taboos and majorities and one of the topics that arouse disgust and is talked about secretly and practiced secretly as well.But today, with international and organizational support for this anomaly and its misrepresentation under the name of gender once again and gender again. It began to spread in all countries of the world, including Islamic and Arab countries, and with the presence of associations and influential people in the legislative and judicial authorities of countries that protect and defend homosexuals. Writing on this subject has become a necessity and a duty; to warn against the

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Publication Date
Wed Jan 01 2020
Journal Name
International Journal Of Innovation, Creativity And Change
The role of the forensic accountant in achieving the integration of accounting and legal performance
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