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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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Mon Feb 28 2022
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Journal Of Educational And Psychological Researches
The Effect of Using the Strategy of Roundhouse in the Achievement of Fourth Grade Students of Computer and Their Attitudes towards It
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The research aims to identify the effect of using the strategy of Roundhouse on the achievement of fourth-grade students of computer and their Attitudes towards it. The research sample consisted of (61) fourth-grade secondary school students distributed into the experimental group consisted of (31) students study computer according to the Roundhouse strategy, and the control group consisted of (30) students follow the traditional method. The researcher designed an achievement test consisting of (30) items of multiple choice. To measure the attitudes of students towards the computer, a questionnaire of (32) paragraphs with three alternatives was designed by the researcher. The results showed that there is a statistically significant diffe

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Sun Sep 11 2022
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Tue Dec 29 2020
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Fri Dec 31 2021
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Political Sciences Journal
The Role of the Iraqi parliament in the adoption of the federal budget after 2005
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Receipt date: 2/2/2021 accepted date: 4/6/2021 Publication date: 12/31/2021

Creative Commons License This work is licensed under a Creative Commons Attribution 4.0 International License.

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Thu Mar 30 2023
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The speech of the "Al Qeyam Al Fatimy " in the requirements of the generalized sayings
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Abstract

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Fri Dec 31 2021
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مجلة العلوم السياسية
The Role of the Iraqi parliament in the adoption of the federal budget after 2005
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