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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 01 2021
Journal Name
International Journal Of Electrical And Computer Engineering (ijece)
Design and implementation of silicon single-photon avalanche photodiode modeling tool for QKD systems
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Single-photon detection concept is the most crucial factor that determines the performance of quantum key distribution (QKD) systems. In this paper, a simulator with time domain visualizers and configurable parameters using continuous time simulation approach is presented for modeling and investigating the performance of single-photon detectors operating in Gieger mode at the wavelength of 830 nm. The widely used C30921S silicon avalanche photodiode was modeled in terms of avalanche pulse, the effect of experiment conditions such as excess voltage, temperature and average photon number on the photon detection efficiency, dark count rate and afterpulse probability. This work shows a general repeatable modeling process for significant perform

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Publication Date
Tue Dec 16 2008
Journal Name
Journal Of Planner And Development
City of Baghdad Analysis of the mechanisms of economic action in the development and development
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The economy of a city has an important role not only in its establishment but also in its development. This is quite clear in the city of Baghdad throughout its history since its building in 762 A.D. In addition, most of its problems that the city is suffering from are basically related to not giving enough importance to the economic factors in the master planning of Baghdad since 1950’s. This may explain the failiars of master plans in dealing with the actual population growth and the city's inability to absorb such increases and interrelated and diverse activities which are negatively reflected on the economic variables particularly the effect on the land values, and the strong competitions amongst the land uses without previ

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Publication Date
Mon Feb 04 2019
Journal Name
Journal Of The College Of Education For Women
The Semantic Relation among the Expressions Of the Phonetic in the Holy Qura: The Semantic Relation among the Expressions Of the Phonetic in the Holy Qura
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Abstract
The phonetic replacement is the process of putting a sound or a linguistic
syllable instead of another in one word that results in changing its meaning . It is one
way of vocabulary varionsness and discrimination because replacement among the
sounds of one expression and changing its image lead to change its meaning , and
accordingly , each replaced sound has its own linguistic value that distinguishes it . In
other words , the phonetic replacement is based on system of phonemic change
which is a general phenomenon in all languages . The linguistic system doesn’t stand
straight for word unless it is based on different standards that work on variousness ,
assortment and relating the phonetic change wi

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Publication Date
Tue Jun 20 2023
Journal Name
Bulletin Of The Iraq Natural History Museum
A COMPARATIVE-MORPHOLOGICAL STUDY OF SKULLS IN TWO SPECIES OF CARNIVOROUS AND HERBIVOROUS MAMMALS
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The skull is one of the largest bones in the body. It is classified into flat bones that maintain the important organic structures; which are the brain, eyes, and tongue. The skull is a strong support for preserving these organs but they are various according to the type of animals and the environments in which they live and the nature of their nutrition. There are many differences among living organisms in terms of the bones in the skull, their difference or disappearance and their length in the shape of the head. The samples were taken from the scientific storage in the Iraq Natural History Research Center and Museum; Cape hare Lepus capensis (Linnaeus, 1758) and Red fox Vulpes vulpes (Linnaeus, 1758) and the study was conducted o

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Publication Date
Tue Jun 20 2023
Journal Name
Bulletin Of The Iraq Natural History Museum
A COMPARATIVE-MORPHOLOGICAL STUDY OF SKULLS IN TWO SPECIES OF CARNIVOROUS AND HERBIVOROUS MAMMALS
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The skull is one of the largest bones in the body. It is classified into flat bones that maintain the important organic structures; which are the brain, eyes, and tongue. The skull is a strong support for preserving these organs but they are various according to the type of animals and the environments in which they live and the nature of their nutrition. There are many differences among living organisms in terms of the bones in the skull, their difference or disappearance and their length in the shape of the head. The samples were taken from the scientific storage in the Iraq Natural History Research Center and Museum; Cape hare Lepus capensis (Linnaeus, 1758) and Red fox Vulpes vulpes (Linnaeus, 1758) and the study was conducted o

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Publication Date
Wed May 14 2025
Journal Name
Journal Of Applied Mathematics
Role of Wind and Fear on the Dynamic of a Prey and Two Competing Predators
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An essential tool for studying the web is its ability to show how energy moves through an ecosystem. Understanding and elucidating the relationship between species variety and their placement within the inclusive trophic dynamics is also beneficial. A food web ecological model with prey and two rival predators under fear and wind flow conditions is developed in this article. The boundedness and positivity of the system’s solution are established mathematically. The stability and existence constraints of the system’s equilibria are examined. The proposed system’s persistence limitations are established. Additionally, the bifurcation analysis of every potential equilibrium is examined using the Sotomayor theorem. To describe the

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Publication Date
Sun Mar 28 2021
Journal Name
Journal Of The College Of Education For Women
The Phenomenon of Phonological Follow in Al-Amali Abi Ali Al-Qali’s Book (seq.356 Hijri): A Phonological Study: هند فاضل عباس
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This research discusses the verbal follow phenomenon in Al-Amali Abi Al-Qali’s book (seq.356 Hijri). It aims to limit the examples of this phenomenon in the book, and  examine it phonologically. Accordingly, the researcher adopted the analaytical descriptive approach, taking into account Al-Rawi’s letter when ordering the verbal follow-based examples, and the order they took in the book in question. The purposes behind this phonological study of verbal follow in Al-Amali’s book are to: reach the sounds which Arabs prefer in the process of following, confirm different beautiful and desirable senses, have easy and speedy pronunciation, maintain harmony between adjacent sounds, count the sounds that occur at the beginning of the

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Publication Date
Mon Jun 01 2009
Journal Name
Journal Of Economics And Administrative Sciences
Simulation of material requirements planning system According to FOQ, EOQ, L4L A study in the General Company for woolen industries / blankets factory
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This paper is submitted as anew approach to simulate manufacturing control & planning system to define the problem of designing control system on the needs for materials.

Production planning & control is a total and complex operation, resides in the essence of manufacturing companies operations. The successful process of production planning and control systems is critical for the staying of manufacturing organizations in markets leading to the increasing consumer competition and which dominate most of manufacturing sectors because of the market oriented economy , thus , what has happened previously , that the companies possessed a great inventory of crude material, components, and groupings and they use in flexible techni

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Publication Date
Sun Mar 19 2023
Journal Name
Nasaq Journal
The impact of the Roundhouse strategy on the achievement of the fifth grade secondary school in physics and their pivotal thinking
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The aim of the research is to study the effect of the roundhouse strategy on the achievement of fifth grade secondary school in physics and their pivotal thinking. The experiment has been applied for obtaining the data, which were processed statistically using the Statistical Package for Social Sciences, the results revealed that the students of the experimental group who studied using the roundhouse strategy was superior to the students of the control group who studied in the traditional method in the achievement exam. The results also show that there are statistically significant differences between the mean scores of the students of the experimental group and the control group in the pivotal thinking exam, in favor of the experimental gr

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Publication Date
Sun Jun 30 2019
Journal Name
International Journal Of Research In Social Sciences And Humanities
CHARACTERISTICS OF THE POWER CHAIN FUNCTION CURVE AND ITS RELATION TO THE ACCURACY OF THE HIGH-JUMP JUMP IN THE HANDBALL
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The skill high-jump scoring is based on mechanical and physical abilities. The most important of all is the strength used by the player from the moment of preparation to the moment of scoring, which led the researchers to study the characteristics of the series of power chain functions of this skill according to (Biosyn System) The players of the national team's back line have a handball to find out the relationship between the properties of the power chain curve and the accuracy of the high jump to the upper and lower target angles. The aim of the research was to identify the values of the Force Series variables for the skill of the high-jump curve of the handball as well as the relationship between the properties of the power chain functi

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