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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 Sep 30 2017
Journal Name
College Of Islamic Sciences
Jinan perish in the Koran: Objective study
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The paradise, the collection of a paradise through which it shows us the wonders of the divine-made, and reflect us the pleasure of looking and luster of beauty, and the splendor of creation, and all this is in the interest of this human being; To be a safety valve to collapse. But if this man deviates and forgot the blessed man, drowned in the vanity and vanity, and deviated from the divine method, this same heaven will disown him and reveal to him another face of destruction and devastation.
What we will see in the folds of the search, God willing

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Publication Date
Mon Jun 01 2009
Journal Name
Journal Of Economics And Administrative Sciences
The contemporary vision of marketing And its impact in crystallizing the chances of success of the new product
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The current research aims at identifying the new marketing directions that in the picture because if the changes and challenges that face the business nowadays, these effect on the future of the new product.

The problem of the research concentrate on the new marketing activities and how to make it appropriate between the product and the market's need, and to fulfill the needs and desire of the customer and it's importance for achieving the economical goals of the organization for a long relationship with the customer.

The resume of the research is about the impact of nowadays marketing and it's effect on knowing the customer instead of concentrating on the important roll of mark

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Publication Date
Tue Jun 15 2021
Journal Name
Al-academy
The authority of identification and alienation of existence in the theater of the oppressed: عبلة عباس خضير التميمي
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This research is represented by exploring the experience of "the theater of the oppressed" by (Augusto Boal) as an experiment that represents a different aesthetic pattern in the presentation of theatrical performance which is in contrast with the Aristotelian and Brechtian patterns, and as a result of the increasing problems of the individual in societies according to his needs and an attempt to express the suffering of human and the loss of his rights in general.
The research also tries to uncover the power of identification and the alienation of existence in the theater of the oppressed as that power, with its diversity of legal, legitimate, religious, political, economic and social capabilities has become a burden instead of being

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Publication Date
Wed Sep 28 2022
Journal Name
Journal Of The College Of Education For Women
The Level of Aligning Scientific Research in Omani Universities with the Era of the Fourth Industrial Revolution in the Light of Oman’s 2040 vision and the Ways of its Development
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The current research aims to reveal the reality of coping the scientific research in Omani universities in the Sultanate of Oman with the requirements of the Fourth Industrial Revolution in the light of Oman’s 2040 vision. It also aims derive some suggestions to develop the scientific research in these institutions. The study has adopted a qualitative approach in which interviews were conducted. The sample consisted of (16) leaders of governmental and private higher education institutions, as well as, some experts in the field of Fourth Industrial Revolution. The theoretical significance of the study is represented by its response to Oman’s vison in 2040. It is further in line with the previous international reports and educational s

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Publication Date
Sun May 15 2022
Journal Name
Bionatura
Survey the Microbial Load in the Tigris River in South of Baghdad City and Some of the Physiochemical Parameters
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This study included an analysis of three stations (Al Dora, Al Za'franiya, and Arab Ejbur) chosen to study the Physiochemical and microorganism (Fungi and Bacteria) loud of the Tigris River in the southern section of Baghdad city. The result of this research shows that the highest temperature recorded in summer in Al Za'franiya was 37Co, while the lowest temperature recorded in winter in Al Dora was 9Co. and the value of pH recorded the highest in summer it was 7.9 in Arab Ejbur, and the lowest value was in winter 7.1 in Al Dora regions, While Total Organic Carbon (TOC) shows the highest values found in the summer was 6.7 Mg L-1in Al Za'franiya Samples, and the lowest values were 2.0 Mg L-1in Arab Ejbur during the winter. The more f

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Publication Date
Sat Apr 30 2022
Journal Name
Periodicals Of Engineering And Natural Sciences (pen)
The role of creative accounting in increasing the marketing of shares and their profits in the Iraqi stock exchange
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As a result of creative accounting, many firms in the Iraqi stock market are able to achieve two very significant goals: first, to boost the market value of their shares and thus gain the biggest trading volume in shares, and second, to lower their earnings in order to decrease the tax burden. First by growing its profits, then by evading taxes and denying the state its right to its money. Using this research, we hope to demonstrate how financial institutions that use innovative accounting tools in the preparation of their financial statements impact trade activity. Trading volume is critical to accurately forecasting stock price patterns, allowing investors to maximize their wealth. So, without accounting information, the financial

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Publication Date
Thu Mar 20 2025
Journal Name
Tikrit Journal Of Engineering Sciences
Effect of Different Compressor Speeds on the Energy and Exergy of an Automobile Air-Conditioner Using R134a in the Absence and Presence of a Liquid-Suction Heat Exchanger
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Refrigerant R134a has been widely utilized in automotive air conditioning systems (AACSs); R134a has a high global warming potential (GWP) of 1430 despite having zero ozone depletion potential (ODP). Coming refrigeration systems must include refrigerants with low GWP and zero ODP. The aim of this experimental study is to evaluate the thermal performance of an (AAC) with different values of compressor speeds, i.e., (1000, 1700, and 2400 rpm) and two thermal loads, i.e., (500 and 1000 Watt) with the absence and presence of liquid suction heat exchanger (LSHX) using R134a. The results showed that adding LSHX enhanced the COP cycle by 7.18%, 10.7%, and 3.09% for the first, second, and third speed, respectively, at 500 Watt, while the en

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Publication Date
Sat Nov 22 2025
Journal Name
Al–bahith Al–a'alami
Challenges Faced by the Media under the Fragile State: Analytical Study of the Iraqi Media Reality
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This study aims at defining the concept of the fragile state, a term that came into existence in 2014, when the states that had internal Problems and external interventions were referred to as the failure states. However, the indicators for their designation and the criteria adopted are 12 indicators that address all aspects of the State’s duties vis-a-vis its citizens. The study examined the reasons that led to the continuation of Iraq within the fragile states, and the selection of the five years within the time limits of the study due to the factors that led to the decline of Iraq and falling back within the most fragile countries. The study dealt with the fragile state challenges to the media reality as a result of the change of it

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Publication Date
Sun Jun 03 2012
Journal Name
Al-kindy College Medical Journal
Ultrasound of the Rotator Cuff: A Comparison of Ultrasonographic and Physical Examination Finding in Seventy Consecutive Cases
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Background : Shoulder pain is a common problem that can pose difficult diagnostic and therapeutic challenges for the family physician It is the third most common musculoskeletal complaint in the general population, and account for 5% of all general practitioners musculoskeletal consults Objective: To determine the diagnostic performance of ultrasonography compared with the physical examination for detection of rotator cuff tears in painful shoulder syndrome. Method: Prospective study was done on seventy patients (48 male, 22 female), age ranged between 30-70 years (mean age 50 years), From February 2007 to July 2011, were subjected to comparative study in Al-Kindy teaching hospital with rotator cuff tears, including physical and ultrasonogr

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Publication Date
Sat Jun 30 2012
Journal Name
Al-kindy College Medical Journal
Ultrasound of the Rotator Cuff: A Comparison of Ultrasonographic and Physical Examination Finding in Seventy Consecutive Cases
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Background : Shoulder pain is a common problem that can pose difficult diagnostic and therapeutic challenges for the family physician It is the third most common musculoskeletal complaint in the general population, and account for 5% of all general practitioners musculoskeletal consults
Objective: To determine the diagnostic performance of ultrasonography compared with the physical examination for detection of rotator cuff tears in painful shoulder syndrome.
Method: Prospective study was done on seventy patients (48 male, 22 female), age ranged between 30-70 years (mean age 50 years), From February 2007 to July 2011, were subjected to comparative study in Al-Kindy teaching hospital with rotator cuff tears, including physical and ul

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