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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
Fri Oct 28 2022
Journal Name
Political Sciences Journal
The dialectic of the relationship between democracy and freedom in the political thought of karl popper
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Recent studies agree that the democratic system in a country can only be established in an atmosphere of political and religious freedom. However, the term democracy and the term freedom have become controversial because their concepts remain multiple and different. Karl Popper is one of the most prominent philosophers in modern Western political thought, and one of the defenders of democracy as opposite to dictatorship. It has defined its function by its ability to restrain the ruling elite and to enforce it to prevent their tendency to tyranny. This can be achieved only in the context of the close relationship between democracy and freedom, so, if there is democracy in the absence of absolute freedom, democracy is a gateway to expandin

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Publication Date
Tue Dec 01 2015
Journal Name
Journal Of Engineering
Valuation the Impact of Risks on the Goals and the Safety of Construction Projects in Iraq
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Construction projects have a special nature and affect them many factors making them exposed to multiple risks as a result of the length of the implementation period and the multiplicity of stages, starting from the decision stage through implementation until the final delivery, which leads to increased uncertainty and the likelihood of risk.
The process of analysis and risk management is one of the effective and productive methods that are used in managing the construction projects for the purpose of increasing the chances of ending the project successfully in terms of cost, time and quality and at the lowest possible problems.

The research aims first to the effective planning for analysis and risk managemen

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Publication Date
Sat Jul 01 2006
Journal Name
Saudi Medical Journal
Treatment of alopecia areata by topical diclofenac sodium gel in comparison to benzoyl peroxide gel. A novel single blind therapeutic clinical trial
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KE Sharquie, AA Al-Nuaimy, WJ Kadhum, Saudi medical journal, 2006 - Cited by 3

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Publication Date
Wed Mar 30 2016
Journal Name
College Of Islamic Sciences
Context and its impact on the choice of Quranic singularity An applied study in some verses of repetition
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The research dealt with the study of choice between a range of different words between the repetitive texts in the verses of the Koran and explain the reason behind this choice, and how the context has the greatest impact in this choice, and that each word in the Koran was placed in the most appropriate place, which can not be replaced by equivalent words, whatever The degree of similarity between them in the indication of the other because it remains at the end that each of those vocabulary synonyms are indicative, the first of them especially that makes the possibility of replacing them with the equivalent vocabulary impossible, and the second general significance and this connotation makes them share with their peers In one aspect of

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Publication Date
Fri Jul 01 2016
Journal Name
Bulletin Of The Iraq Natural History Museum (p-issn: 1017-8678 , E-issn: 2311-9799)
STUDY THE EFFECT OF DIFFERENT TYPES OF STRESS ON SOME BLOOD CONSTITUENTS AND PLASMA BIOCHAMICALS IN MALE RATS
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    The objective of this work was to determine and compare the physiological changes in some: blood components (packed cell volume and hemoglobin) and plasma biochemical parameters (glucose, total protein, albumin, cholesterol and triglycerides) under 3 day of different types of stress: water deprivation, starvation, overcrowding and handling stress. Twenty five male Wister rats weighted 100-120 gm, were divided randomly into five groups: control, water deprivation, starvation, overcrowding and handling stress. On the third day of stress the animals anesthetized for blood collection; the results of blood component revealed a significant increase in PCV and a significant decrease in Hb of water deprivation group and starva

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Publication Date
Sun Jun 06 2010
Journal Name
Baghdad Science Journal
Study the effect of Grave's disease on the different tissues and organs of the body by using Wayne Thyrotoxicosis Diagnostic Index(WTDI) and Basel Metabolic Index(BMI)
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The present work aimed to study the effect of Grave's disease on the different tissues and organs of the body by using Wayne Thyrotoxicosis Diagnostic Index (WTDI) and Basel Metabolic Index (BMI). To reach such aim, (35) patients were involved (25 females and 10 males). A control group of (15) healthy individuals (10 females and 5 males) was selected for comparison , as well as , the following: 1- Wayne Thyrotoxicosis Diagnostic Index (WTDI) applied on patient group and control group under the supervision of specialist medical team , this index include (19) sign and symptom , the appearance of one of them may be lead to the others. The sings and symptoms of the index appear only on the patients. There is no Significant di

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Publication Date
Thu Sep 15 2022
Journal Name
Alustath Journal For Human And Social Sciences
The Impact of Mind and Informational Strategy on the ‎Achievement of the Second Intermediate Students in the Grammar ‎of Arabic Language
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The aim of the current research is to recognizing the impact of mind and informational strategy on the achievement with the second intermediate students in the grammar of arabic language, the researcher used a partial-set experimental design and intentionally selected a sample out of the second intermediate class from (AL- Markazya Intermediate school) in the district of Hilla, affiliated which belongs to General Directorate of Babylon Education in the year (2020-2021) for applying the experiment. The sample was composed of (50) students, (25) ones for each group, the experimental group and normal one. The researcher balanced between the two groups in various changes including: (the chronological age counted by months, the academic achie

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Publication Date
Mon Jan 01 2024
Journal Name
International Journal Of Literacy And Education
The availability of concepts and applications of artificial intelligence in the content of the chemistry textbook for the fourth scientific grade
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Publication Date
Wed May 17 2023
Journal Name
Journal Of Engineering
A Simulation of Core Displacement Experiments for the Determination of the Relative Permeability
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Computations of the relative permeability curves were made through their representation by two functions for wetting and nonwetting phases. Each function contains one parameter that controls the shape of the relative permeability curves. The values of these parameters are chosen to minimize an objective function, that is represented as a weighted sum of the squared differences between experimentally measured data and the corresponding data calculated by a mathematical model simulating the experiment. These data comprise the pressure drop across core samples and the recovery response of the displacing phase. Two mathematical models are constructed in this study to simulate incompressible, one-dimensional, two-phase flow. The first model d

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Publication Date
Mon Dec 21 2020
Journal Name
Bulletin Of The Iraq Natural History Museum (p-issn: 1017-8678 , E-issn: 2311-9799)
A CONTRIBUTION TO THE CHECKLIST OF THE JUMPING SPIDERS (ARANEAE: SALTICIDAE) OF ARMENIA
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The paper presents an annotated checklist of the Salticidae of Armenia. This study was carried out in 2019-2020 in order to provide an inventory of the Salticidae fauna. Thirteen species are reported for the Armenian fauna for the first time: Afraflacilla epiblemoides (Chyzer, 1891); Aelurillus v-insignitus (Clerck, 1757); Asianellus festivus (C. L. Koch, 1834); Heliophanus dubius C. L. Koch, 1835; Heliophanus kochii Simon, 1868; Heliophanus tribulosus Simon, 1868; Heliophanus curvidens (O. Pickard-Cambridge, 1872); Macaroeris nidicolens (Walckenaer, 1802); Pellenes diagonalis (Simon, 1868); Pellenes geniculatus (Simon, 1868); Pellenes seriatus (Thorell, 1875); Pellenes tripunctatus (Walckenaer, 1802) and Phlegra fasciata (Hahn, 1826).

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