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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 Nov 22 2025
Journal Name
Al–bahith Al–a'alami
International Public Relations (An Analytical Study of the Speeches of US President Barack Obama Addressed to the Arab Countries in Crisis)
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In the midst of political, cultural and economic fast developments accelerated, the world witnessed, with the accompanied big communication revolutions, many shapes of powers. Those developments were followed by changes in relations of international level.

The most prominent among those developments was the international public relations which became equal to official international relations. Moreover, the international public relations became a complementary element dur to the growth of public opinion and its affection on political regime. Such growth of public opinion pushed the politicians to address it; and try to gain its support.

The US was the first realized the importance of international public relations. Th

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Publication Date
Tue Sep 15 2020
Journal Name
Al-academy
The Constant and the Variable in the Aesthetic Image of the Theatrical Direction: حازم عبد المجيد إسماعيل
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The theatre is one of the main pillars of the human aesthetic thinking as it contains logical explanations for the public human life aspects outside time and environment. When we find that the directive philosophical thinking moving away from the stylistic constants and the virtual laws in taboos that control the accomplishment in terms of the traditional shapes, the employment and the theatrical reception. Some directors moved in post-modernism concepts in a perceptive that liberates thought from its natural context in thinking into an innovative perceptive. The aesthetic images are the basic premise in the prohibition of the philosophical thinking interpretation in order to move the directive thinking and this movement depends on the v

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Publication Date
Tue Feb 05 2019
Journal Name
Journal Of The College Of Education For Women
Shortcomings mentioned by the Torah about the prophet Lot in the prophecies and the respond of Quran
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Praise be to Allah , and peace and blessings of God sent mercy to the worlds Muhammad
Amin and his family and his friends and followers to the Day of Judgement .
Savants Jews worked to distort the Torah calamity on the Prophet Moses ( peace be upon
him ) to achieve their goals and objectives , which are decorating sin to their followers , and
spreading corruption on earth, through the charge prophets Bmvassad , morality, as the
example and the example that emulate the human in the book of the Lord of the worlds and
their Prophet Lot, described the weak, and cheese, and lack of modesty, and disobedience ,
drinking alcohol , and his failure to raise his two daughters , Jews are corrupt in the ground .
Koran , which

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Publication Date
Mon Jan 01 2018
Journal Name
Al–bahith Al–a'alami
The Interactive Relationship between the Formation Elements and their Implications in the Structure of the Television Image
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The image of television dominates the cognitive and artistic motivations. It is the formulation of ideas and visions along with its documentary ability. It is the main element in television work as it is a story that is narrated in pictures. Therefore, attention to image building is a major point of gravity in the work structure as a whole. On the image is the element carrying all aesthetic and expressive values of news and information directly to the hints that work to stimulate and stir the imagination of the recipient to evoke mental images added to the visual images to deepen the meanings.
All visual arts carry elements and components that follow in a particular pattern to give special meanings and specific connotations. However,

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Publication Date
Wed Mar 16 2022
Journal Name
Journal Of Educational And Psychological Researches
The Effect of a Training Program to Develop the Skill of Organizing Time for the Kindergarten Department Students
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The current research aims to identify the time-management skills based on the post-test of the experimental group as well as to examine the effect of a training program on developing the skills of managing time among the study sample. To achieve the research objectives, the researcher designed a scale of time management skill included (30) paragraphs. The research reached that the training program is significantly effective in managing and organizing time. There are statistically significant differences in pre-posttest between the experimental and control groups.

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Publication Date
Wed Jul 24 2024
Journal Name
An International Journal Of Optimization And Control: Theories &amp; Applications (ijocta)
The effect of a psychological scare on the dynamics of the tumor-immune interaction with optimal control strategy
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Contracting cancer typically induces a state of terror among the individuals who are affected. Exploring how chemotherapy and anxiety work together to affect the speed at which cancer cells multiply and the immune system’s response model is necessary to come up with ways to stop the spread of cancer. This paper proposes a mathematical model to investigate the impact of psychological scare and chemotherapy on the interaction of cancer and immunity. The proposed model is accurately described. The focus of the model’s dynamic analysis is to identify the potential equilibrium locations. According to the analysis, it is possible to establish three equilibrium positions. The stability analysis reveals that all equilibrium points consi

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Publication Date
Sat Nov 22 2025
Journal Name
Journal Of Al-turath University College
The role of the Prophet ( peace be upon him and progeny) in the field of the Administration Regulation and applying Shura Principle Council in Islamic State Administration
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Publication Date
Tue Jan 01 2019
Journal Name
Izvestiya Of Saratov University. New Series. Series: Philology. Journalism
To the Question of Internal Inflection of the Roots in Arabic and Russian (Inflected Analysis of the Root Structure)
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Publication Date
Sat Nov 22 2025
Journal Name
Journal Of Physical Education
The reality of the heroic graduate students in the College of Physical Education and Sports Sciences, University of Baghdad
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Publication Date
Tue Dec 01 2015
Journal Name
Journal Of Economics And Administrative Sciences
Analysis of some of the success factors and product strategies Applied Research in the industrial sector of the Iraqi
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This research deals with the study of the relationship between the success factors as the independent variable and product strategies as the dependent variable , has reacted to these variables to form the frame , which is the research which centered research problem about the extent to which industrial companies the vision and knowledge of Muslim women survive and develop in the business market , which can be expressed about the extent of awareness of corporate success factors and the use of product strategies and what the relationship between the factors and strategies , while expressing the importance of research to make the focus on the product occupies a paramount importance in the industrial sector companies in relation to t

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