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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
Tue Mar 30 2021
Journal Name
College Of Islamic Sciences
The authority of the ancient text in the poetry of Bashar bin Bard
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Abstract

Heritage represents the center around which poets revolve around and take advantage of its inexhaustible specific, and the connotations that this heritage holds of various values, values ​​and ideas, and the poet Bashar bin Bard from prominent poets who were inspired by that heritage and the culture of the first Abbasid era and whoever and others was worthy of studying and tracking his potentials and capabilities Creativity is based on the inspiration of the legacy of his predecessors, and the development of this legacy and renewal in it. The research methodology required its division into two topics, the first topic, a description of the beauty of women, a description of wine, while the second topic is a description

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Publication Date
Tue Aug 20 2019
Journal Name
Political Sciences Journal
The future role of the military establishment in the political life of Egypt
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There are certain dates in the history of nations that have their effects on them ,and the 25th of January 2011 is considered one of them in the history of the state of Egypt .Since this date Egypt has passed through many events that led to changes in the political life and its actors . New rolls has arisen for actors that didn't take part in the political life before so clearly ,like the military establishment which started to practice more prominent political roll, till it became the most important actor in the political life of Egypt .This establishment tried to institutionalize its roll through constitutional means ,considering that controlling the authority is the only alternative to safeguard the state which we are trying to study

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Publication Date
Mon Jun 23 2025
Journal Name
Sabir
The importance of teaching the diatopic variety of Spanish in the ELE classroom
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Trends in the teaching of Spanish in terms of diatopic variables have had a significant change around the world, thanks to the evolution of technology, teaching approaches, processes and methods, pan-Hispanic policies and the reason why a person studies this language, which has caught the attention of linguistic researchers who teach Spanish around the world. Hence, the objective of this research is to show the scientific production regarding opinion trends in the teaching-learning processes of diatopic variables in the Ele classroom indexed in Scielo, Dialnet plus, Redalyc.org, Dialnet. unirioja .es, Researchgate.net, and Google Scholar, Thematic analysis was used to analyze the opinions of linguistic researchers. Of the 6 articles analyze

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Publication Date
Thu Jan 25 2024
Journal Name
Entrepreneurship Journal For Fiinance And Business
The role of psychological ownerships' dimensions in deterring the effects of toxic leadership: Analytical research in some companies at the Ministry of Industry and Minerals in Iraq
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The research aims to clarify the role that psychological ownership, through its dimensions, plays in deterring the effects of toxic leadership, through its dimensions, in the Ministry of Industry and Minerals. The research started with a basic problem represented by the following question: "Using psychological ownership and its application in deterring the negative effects of toxic leadership." The research used the descriptive-analytical method. The sample was randomly selected from workers in some selected companies affiliated with the Ministry of Industry and Minerals in Baghdad, and the sample size reached 124 individuals. One of the most important results is that there is an effect of the psychological ownership variable, based on the

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Publication Date
Mon Jun 01 2009
Journal Name
Journal Of Economics And Administrative Sciences
Use sensitivity analysis in evaluating projects Investment under the conditions of risk and uncertainty Case study of glass bottles project in Anbar province
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This paper studies the investment project evaluation under the condition of uncertainty. Evaluation of investment project under risk and uncertainty is possible to be carried out through application of various methods and techniques. The best known methods are : Risk-adjusted discount rate , certainty equivalent method , Sensitivity analysis and Simulation method The objective of this study is using the sensitivity analysis in evaluation Glass Bottles project  in Anbar province under the condition of risk and uncertainty.

After applying sensitivity analysis we found that the glass bottles project  sensitive to the following factors (cash flow, the cost of investment, and the pro

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Publication Date
Wed Oct 31 2018
Journal Name
International Journal Of Research In Pharmaceutical Sciences
The impact of systemic hypertension-related heart remodeling on right ventricle mechanics: A two-dimensional echocardiographic speckle tracking study
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Publication Date
Sat Apr 01 2017
Journal Name
Journal Of Economics And Administrative Sciences
Risk Analysis of Projects Accordance with the Professional Project Management System: A case- Study Mansur Construction Contracting Company here
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The research aims to identify the risks faced by projects and work on the administration, such as those risks by using professional Project Management System (Project Management Professional) by identifying those risks and their impact on the objectives of the project, if they occur and to provide appropriate responses to Ha.autam search application on the draft Law Faculty port by the General Mansour Construction Contracting company has been using a method personal interview with the heads of departments and project managers in the Al-Mansour and tools descriptive and quantitative analysis as was used (likelihood and impact of risk analysis, Ai_kaoa scheme Sbb- effect, analysis of probability and impact, risk matrix (probability

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Publication Date
Tue Aug 03 2021
Journal Name
Journal Of Accounting And Financial Studies ( Jafs )
The role of coordination and joint cooperation in raising the quality of auditing in accordance with the INTOSAI standard(9150 (: Applied research in the General Company for Marketing Medicines and Medical Appliances - Kimadia
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The process of coordination and joint cooperation between SAIs and internal auditors in the public sector is considered one of the very important matters in performing efficient audits and are of high quality, especially if this coordination and cooperation is implemented in accordance with international standards, as it leads to avoiding duplication in auditing work. And the distribution of work in a distribution that achieves the objectives of auditing in general and is of general benefit to the economic unit.

The research problem lies in the weakness of the relationship between internal auditing and external auditing as a result of not applying INTOSAI Standard (9150) coordination and joint cooperation

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Publication Date
Thu Nov 01 2018
Journal Name
Journal Of Economics And Administrative Sciences
The Extent of application the principles of total quality management in Improving health services in hospitals exploratory study at Al-kindi hospital / Baghdad health department Rusafa
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Abstract :

The purpose of the subject of Total quality management is an important management style in organizations including hospitals through the achievement of this method of success in the administration to include        this approach describes the provision of health services and make adjustment and suggestions that  help to improve the quality of health care on an ongoing basis . Hence the idea of the study to shed light on the reality of the application of principles of  Total quality management and to highlight the quality of health services provided in al-kindi hospital / Baghdad health department rusafa and the staff at the hospital were included to find out the appl

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Publication Date
Thu Jun 18 2020
Journal Name
Rimak International Journal Of Humanities And Social Sciences
STRESS IN ENGLISH AND ARABIC: A CONTRASTIVE STUDY
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DBN Rashid, Rimak International Journal of Humanities and Social Sciences, 2020

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