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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 Jun 01 2013
Journal Name
Journal Of Economics And Administrative Sciences
Test the effectiveness of transactional and transformational leadership in the Egyptian Environment
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       The present study aims to test a range of hypotheses about the effectiveness of each of the theory of transactional leadership, and the theory of transformational leadership in the Egyptian environment, and to identify any of them are better able to predict the effectiveness of leadership. And after the effect will be to identify the quality of the relationship between the leader and the subordinate in leadership , and what is the role of transformational leadership dimensions influencing the effectiveness of leadership. The field study was conducted on a sample of companies' public and private sector and the government in Egypt. The results of the study resulted in experimental that transacti

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Publication Date
Tue Mar 30 2021
Journal Name
College Of Islamic Sciences
The wisdom of establishing the right by testimony in jurisprudence and law
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Abstract

Islam has been concerned with preserving and maintaining rights, so the provisions in which it is preserved are legislated. Among that  is the testimony that made it a way to prove the truth and obliges its bearer to fulfill right in order to preserve the right and establish justice and prevent injustices by defying conflict, and tyranny .

And while acknowledging that divine absolute wisdom that is the cause and origin of legal rulings is sufficient, it is obligatory to abide by its provisions and imposes obedience, surrender, contentment and work in accordance with its controls.

However, the realization of the defects behind the legislation in a comprehensive way that realizes the dev

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Publication Date
Thu Feb 07 2019
Journal Name
Journal Of The College Of Education For Women
The Redemptive Vision of the Heart and Mind in Margaret Edson's Wit
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Approaching the turning of the millennium, the American theatre witnessed an arousing
interest much shown in patients suffering of severe diseases as a subject matter to drama. In a
discussion of Margaret Edson's Wit, the light is shed on how far such patients, who were literally
involved in secular visions during their life-time, become apt to create a different one on their
death beds. The vision newly blossomed becomes much rooted in the spiritual life; it is a
redemptive vision that can amend what those patients' hearts and minds have long ignored.
Further, the human touch that has been ignored during man's healthy secular life is ultimately
needed for the time being. It helps to enhance man's vision towards the

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Publication Date
Wed Sep 30 2015
Journal Name
College Of Islamic Sciences
Break in the bond And its impact on the difference of scholars
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Break in the bond and its impact on the difference of scholars

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Publication Date
Mon Jan 01 2018
Journal Name
Proceedings Of The 2018 4th International Conference On Humanities And Social Science Research (ichssr 2018)
The Artistic directions in stalactites of the antiquarian and religious buildings minarets
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Publication Date
Tue Mar 15 2022
Journal Name
Al-academy
The human self and its representations in the works of Salvador Dali
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The products of the surrealist school since its inception to this day have greatly influenced art in the world, so we find many artists around the world invested in their visual texts the forms generated by surrealism, and here the researcher raises several questions: What are the formal vocabulary that directly or indirectly refers to Self-used by the surrealist painter? Was the surrealist form understood as intended by the movement? In these questions, the research problem is summarized. The importance of it lies in identifying the references to the form of the human self, which are related to the psychological field in the works of the surrealists, especially Salvador Dali. Then the researcher chose his research community from the wor

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Publication Date
Wed Aug 01 2018
Journal Name
Journal Of Economics And Administrative Sciences
Social orientation of the marketing and its role in the competitive strategies
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     This research shed light on the relationship between the social orientation of the marketing (interests of the Organization ,the welfare of society, satisfaction the customer) strategies competitive dimensions of (cost leadership strategy, differentiation strategy, focus and strategy), As well as to to seek to achieve a number of knowledge and applied goals, and represented the field research problem extent of interesting researched the application of social orientation and interest in achieving competitive strategy and omission of this interest in the hotels the surveyed Organization, Based on this problem, and to clarify the relationshi

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Publication Date
Sat Jun 01 2019
Journal Name
Journal Of Economics And Administrative Sciences
The auditor's qualifications and their role in the quality of professional performance
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Abstract

The aim of the research is to clarify the requirements of the qualification of the external auditor in Iraq and the extent of their impact on the quality of the professional performance of the audit process. The research was based on analyzing the results of the questionnaire prepared for the impact of qualifications on the quality of professional performance. The researcher has reached a number of conclusions, the most important of which is that a highly qualified and unethical auditor has a greater negative impact on the quality of professional performance than those with low qualifications. The most important recommendations of the research were the need to pay

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Crossref
Publication Date
Mon Feb 01 2016
Journal Name
Journal Of Economics And Administrative Sciences
Audit strategies and their role in the quality of the business audit
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Increased the need to promote the profession of auditing, and improving the performance of the audit process, which comes through the effective implementation of its tasks, where the auditor collects the necessary data about the nature of client activity, and any other information it deems necessary to carry out the planning and development of the strategy for how to determine the procedures for implementing the audit process and the scope and timing for evidence clues in order to form an opinion technician neutral about the fairness of the financial statements, as required by the standards of the field work of the planning and supervision of the internal control and evidence to prove, but the failure of the auditor whether in th

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Crossref
Publication Date
Sun Dec 02 2018
Journal Name
Journal Of The College Of Education For Women
The Ecologia and Abbasid's Community/ Historical-Ecological Study
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The study includes the relationship between the ecologia and Abbaside's community in the middle ages, and the role of Baghdad capital city to increasing the sensibility of the people to the outwardly peripheral.

The study explains the efforts between the people and Abbaside's government to cure the knowledge of ecologia, to prevent the separation of diseases and  pollutions of the community. 

 Keywords: Ecologia, Abbasid's, diseases, pollutions.

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