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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
Wed Oct 05 2016
Journal Name
Al-academy
The concept of rhythm in the play
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The training of great importance in the play, in building optic and intellectual broadcast codes tags, and then comes after the recipient at the reception of such codes and decoded tags, and is the rhythm, the color of the most important elements of configuration, consistent with other elements, Kaltmathl, and focus, and harmony, and dissonance

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Publication Date
Fri Oct 30 2020
Journal Name
Journal Of Economics And Administrative Sciences
The effect of applying total quality management on the competitiveness from the point of view of the front-rows employees for customer service (An analytical study of Palestinian local banks)
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The study aimed to identify the effect of Total Quality Management on enhancing competitiveness through the opinions of employees of the front- rows of customer service in local Palestinian banks, the researcher adopted an analytical descriptive method through developing a special questionnaire to accomplish the study’s objectives and answer its questions. The study involved all the Palestinian local banks, with their scattered branches in West Bank. The study sample consisted of 3470 executive employees for banking services out of 4753 employees, in the rate of 73%, and the study sample reached (485) employees who were randomly selected working in the front -rows to provide services in the local Palestinian banks during the ye

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Publication Date
Sun Oct 01 2017
Journal Name
Journal Of Educational And Psychological Researches
The effect of using active learning model in the achievement of fourth -grade material in the de partment of physics teaching aids students and the development then critical thinking
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Goal  of  research  is  to  investigate  the  impact  of the  use  of  effective  learning  model in the  collection  of  the  fourth  grade  students/Department of  physics in the material  educational methods  and the  development  of  critical thinking  .to teach  this goal  has  been  formulated  hypothesis cefereeten zero  subsidiary  of the second hypothesis  .To  investigate  the  research  hypothesis  were  selected  sample  of  fourth-grade  students of the  department  of physics at the univers

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Publication Date
Thu Sep 01 2011
Journal Name
Journal Of Economics And Administrative Sciences
Leadership ethics and transformational leadership to develop perceptions of organizational work supportA survey of a sample of the staff of the Ministry of Water Resources
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The aim of organizational contemporary is development man power active, in spit-of there are littlie resources. But in the Iraqi environment there are too much resources with performance inhabiting. specially in the ministry of water resources (sample of this research), about dryness and lower levels of rivers. There for this study have some important variable, it is ethical leadership & transformational leadership as (independent variable), and Perceived organizational support(dependent variable). Over here to invest with authority on the problem of research, is weakness harmony between employed perception and the pattern of leadership. We find decline in of reaction of organ compound between the variable to weaken high perf

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Publication Date
Sun Mar 01 2020
Journal Name
Journal Of Engineering
Flow Characteristics Of Tigris River Within Baghdad City During Drought
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The main source of water supply in Iraq is the surface water, especially Tigris and Euphrates Rivers and their tributaries. In the recent years there was a great drop in the water levels of Tigris River within Baghdad City which had affected the operation of twelve water supply projects located on the banks of Tigris River in Baghdad City, due to significant climate changes, and the expansion of hydraulic construction (dams) and implementation of new irrigation projects in Turkey, these factors have greatly reduced the water flowrates of river by about 46%. In the present study the flow characteristics of Tigris River within Baghdad City was studied, the reach involved was about 49km in which it represents the urban zone

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Publication Date
Sat Aug 01 2020
Journal Name
Journal Of Engineering
Statistical Analysis of Metal Removal during Magnetic Abrasive Finishing Process
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This work aims to provide a statistical analysis of metal removal during the Magnetic Abrasive Finishing process (MAF) and find out the mathematical model which describes the relationship between the process parameters and metal removal, also estimate the impact of the parameters on metal removal. In this study, the single point incremental forming was used to form the truncated cone made of low carbon steel (1008-AISI) based on the Z-level tool path. Then the finishing was accomplished using a magnetic abrasive process based on the Box-Behnken design of the experiment using Minitab 17 software was used to finish the surface of the formed truncated cone. The influences of different parameters (feed rate, machining step s

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Publication Date
Sun Jan 08 2017
Journal Name
International Journal Of Information Technology And Computer Science
Adaptive Modeling of Urban Dynamics during Armada Event using CDRs
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Publication Date
Sat Jun 06 2020
Journal Name
Journal Of The College Of Education For Women
The Neurosis of Blackness and Psychological Trauma in Edward Albee's The Death of Bessie Smith
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      Edward Albee, as a playwright, indicates that art should be useful and have a message. Therefore, his work foregrounds and critically examines issues concerning the Neurosis of Blackness and psychological trauma. Albee uses cruelty of racism in reflecting psychological trauma and emotional abuse of American black identity in his plays. Race, social inequality, and gender still sustain to engender controversy audience consciously. Racial discrimination is one of the major issues that affect the American Society. Albee challenges and exposes the presumptive dreams of equality of American society and institutional racism. Therefore, one of the main problems of the twentieth century in America is skin color. It

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Publication Date
Wed Sep 15 2021
Journal Name
Journal Of Baghdad College Of Dentistry
The estimation of the viable count of mutans streptococcus in waterpipe smokers and cigarette smokers
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Background: Waterpipe and cigarette are two products of tobacco consumption, tobacco use has detrimental effects on the oral cavity, numerous studies around the world have reported a significant relationship between smoking and increase dental caries and viable count of cariogenic bacteria, Materials and Methods: unstimulated saliva was collected from 84 subjects and divided equally into three groups waterpipe smokers, cigarette smokers, and non-smokers all of the participants are adult male aged between 25-60 years, dental caries was measured by use DMFT index, while S.mutans and S.sobrinus were isolated by using a selective medium SB 20M (Sugar bacitracin-20 modified) agar Results: this present study showed a significant (p≤0.01)

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Publication Date
Sun Jan 01 2023
Journal Name
Revista Iberoamericana De Psicología Del Ejercicio Y El Deporte
EXPLORING THE MODELING OF SOCIO-TECHNICAL SYSTEMS IN THE FIELDS OF SPORT, ENGINEERING AND ECONOMICS
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