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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
Thu Jan 02 2020
Journal Name
Journal Of The College Of Languages (jcl)
The personality of the woman and her role in the products of Agnon: דמותה ותפקידה של האישה ביצירותיו של עגנון
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  Shmuel Yosef Agnon, a well-known Jewish writer, wrote many literary works, including poetry, story, etc. In the field of story, this writer used two areas: the first: a simple exterior, and the second: an inner full of secrets and mysteries. This area is common when Agnon is affected by his symbolic method of purpose. In his productions, we find the political and historical significance embodied in his characters, where there is almost no story without it.

    Agnon and all his productions gave the character a large area, Agnon’s characters often play the center and cornerstone in those productions, where the author dealt deeply and stated the fines details of the external and internal of that ch

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Publication Date
Sun May 15 2022
Journal Name
Bionatura
Comparison between the presence and absence of mixing in the anaerobic biological treatment of liquid waste for the cheese industry
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Many nations are seeing an increase in water pollution from dairy and cheese production due to the high organic and fat content in their waste products and the high temperature of their waste products, which elevates the water temperature and causes loss to ecosystem components. Reusing industrial wastewater that has been treated to guarantee no harm has been done to the environment is being hampered by a lack of water. This study compares the presence and absence of mixing in the anaerobic biological treatment of liquid waste for the cheese industry. To decrease heat exchange with the external environment, cube-shaped anaerobic reactors with dimensions of (30 x 30 x 30) cm and thick glass (10 mm) were utilized in this investigation

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Publication Date
Thu Jan 02 2020
Journal Name
Journal Of The College Of Languages (jcl)
The composition of the vocabulary and passages in the poems of Saadi: بررسی ترکیب‌ سازی در قصاید و قطعات سعدی
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The importance of research and study of classical Persian literature is not overlooked.  So far, there have been many studies in this area.  But there are still some things that need more research.  Persian grammar is one of the most important branches of Persian literature.  This section has always been converted at different times.  One of the issues that has been neglected in the studies of classical literature is the study of the technical tales of past and past poetry.  These texts can be studied from different perspectives.  Because Persian is a mixed language, it is possible to combine language terms with each other or to add prefixes and suffixes to express new concepts. They can be used by exam

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Publication Date
Fri Aug 25 2023
Journal Name
Enterprenuership Journal For Finance And Bussiness
Argumentative Accounting conservatism and the performance of institutions listed on the Iraq Stock Exchange in light of the Coronavirus pandemic
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This study aims to test whether the institutions listed on the Iraq Stock Exchange have a significant correlation between the level of conservative accounting practice with the level of market share returns during the Coronavirus pandemic period as one of the policies to confront the economic repercussions of the Coronavirus pandemic. Furthermore, the sample included institutions listed on the Iraq Stock Exchange during the 2019 and 2020 years, i.e., the period before the Coronavirus pandemic and during the Coronavirus pandemic for the purpose of comparison. The market value to book value model was used, and the study found that conservative institutions had achieved the highest level of market share prices compared to non-conservat

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Publication Date
Sun Nov 23 2025
Journal Name
Journal Of Language Studies
Opening the Box of Suffering, Unleashing the Evils of the World’: Pandora and her Representation in Nineteenth-Century American Poetry
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Publication Date
Wed Aug 01 2018
Journal Name
Journal Of Economics And Administrative Sciences
The mediator role of the psychological contract in light of the linking between training needs and organizational commitment - exploratory search
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  The purpose of this research shed light on the analysis of the relationship between training needs and organizational commitment and the role of a variable contract psychological, and start search of a dilemma thought provoking fundamental questions revolve around the search was the answer to all those questions of tricks theoretical framework to the variables of research first and test models of the relationship and impact secondly During six hypotheses major, The objective of the research the impact of the factors that affect training needs in organizational commitment center the psychological contract, and applied research on a sample of 100 individuals working in the engineering department and maintenance at the D

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Publication Date
Fri May 01 2020
Journal Name
International Journal Of Psychosocial Rehabilitation
The Psychological Pollution And Its Role In The Effectiveness Of The Administrative Performance Of International Stadiums Staff (Baghdad, Arbil, Basrah)
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MT Abed, ALSG Irhayyim, TH Rija, International Journal of Psychosocial Rehabilitation, 2020 - Cited by 1

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Publication Date
Wed Oct 17 2018
Journal Name
Journal Of Economics And Administrative Sciences
Implications of Financial Reporting Governance in rationalizing investors decisions In financial markets in light of An International Financial Reporting Standards (IFRS)/ An analytical study of a selected sample of the joint stock companies in Iraq
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The financial crises that occurred in South East Asia and America, and the discovery of the financial and administrative corruption that affected these companies, which led to the crisis. Since then, organizations and institutions interested in accounting have begun new ways to further rationalize the management of these companies. Hence the concept of governance, which means good governance. Al-Susiya confirmed its adoption of the financial reporting standards and adopted internal and external auditing for the purpose of increasing the reliability and credibility of the financial and reports that increase the confidence of investors in making their investment decisions in the financial markets The study dealt with the contributi

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Publication Date
Sun Mar 19 2023
Journal Name
Journal Of Educational And Psychological Researches
Degree of Practicing the Professional Leadership of the Faculties’ Deans, Their Deputies and Heads of the Scientific Divisions in Al-Qaseem University
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Abstract

The study aims to find out the degree of practicing professional leadership of the faculty’s deans, deputies, and heads of the scientific divisions at Al-Qaseem University. The study has adopted the descriptive analytical method. To achieve the objective of the study, the researcher developed a questionnaire consisting of (45) items distributed to six fields that were applied to a sample of (116) faculty deans, deputies, and the head of division at Al-Qaseem University. The results showed there is a high practicing degree of the study sample individuals of the professional leadership on the questionnaire’s fields as a whole, strategic thinking field came at the first rank, while the innovation, creat

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Publication Date
Thu Feb 01 2018
Journal Name
Journal Of Economics And Administrative Sciences
the administrative investigation and its impact on the performance of the offices of the inspectors General.
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The purpose of this research is to highlight the relationship between the   administrative investigation and the improvement of institutional performance, and the research sought to achieve a set of cognitive and applied goals. the administrative investigation is the modern trend of managing the offices of the general  hginspectors and the main source to build the necessary standards to manage and invest its resources efficiently and effectively required to achieve the goals it seeks. The institutional performance is the cornerstone for the implementation of all tasks and duties carried out by institutions operating within the borders of a particular country, The significant change

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