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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 09 2019
Journal Name
Journal Of The College Of Education For Women
Naber and toning in the modern Arab poetry Mahmoud Darwish, a model
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Naber and toning in the modern Arab poetry Mahmoud Darwish, a model

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Publication Date
Thu Sep 30 2010
Journal Name
Iraqi Journal Of Chemical And Petroleum Engineering
USING ALUMINUM REFUSE AS A COAGULANT IN THE COAGULATION AND FLIOCCULATION PROCESSES
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The present work aims to study the efficiency of using aluminum refuse, which is available locally (after dissolving it in sodium hydroxide), with different coagulants like alum [Al2 (SO4)3.18H2O], Ferric chloride FeCl3 and polyaluminum chloride (PACl) to improve the quality of water. The results showed that using this coagulant in the flocculation process gave high results in the removal of turbidity as well as improving the quality of water by precipitating a great deal of ions causing hardness. From the experimental results of the Jar test, the optimum alum dosages are (25, 50 and 70 ppm), ferric chloride dosages are (15, 40 and 60 ppm) and polyaluminum chloride dosages were (10, 35 and 55 ppm) for initial water turbidity (100, 500 an

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Publication Date
Mon Sep 03 2018
Journal Name
Al-academy
The privacy of the interior design of art education spaces in the schools of excellence
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The current research deals with the specificity of the interior design of the classes of art education in the schools of excellence for the province of Muthanna and its center of the city of Samawah. In the first chapter، the problem of research was determined by the lack of internal spaces of the classes of art education to designs that meet the requirements and needs of students in these educational stages.  The importance of the research in being an addition to knowledge in the field of interior design and engineering department of the general directorates of the Ministry of Education. The objectives of the research were determined through.

  1. Identifying the reality of the halls of art education for sch

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Publication Date
Wed Mar 23 2022
Journal Name
Journal Of Educational And Psychological Researches
The Actual Use of Instructional Technology in Teaching History Subject in the Colleges of Education for Humanities from the of the College Staff Members' Perspectives and their Attitudes Towards Them
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The study aims at knowing the actual uses of instructional technology in teaching history subject in the colleges of education for humanities from the college staff members' perspectives and their attitudes towards it. The sample of the study consisted of (24) instructors from the Colleges of Education for the Humanities, the College of Basic Education- Haditha and the College of Education for Women, the study used the descriptive method, and the questionnaire was consisted of (50) items, and the psychometric properties of the instrument of the study were extracted. The researchers used the appropriate statistical means to analyze the data, and the results of the study showed the following: the teaching staff attitudes towards the use of

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Publication Date
Wed Sep 30 2020
Journal Name
Journal Of Accounting And Financial Studies ( Jafs )
Evaluating the extent of the response of the tax administration leaders towards the concept of the strategic lens and its relationship to tax pioneer performance: Applied Research in the General Authority for taxes
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The aim of the research is to evaluate the response of the researched leaders towards practicing the concept of the lens, which is its dimensions with (stakeholders, resource mobilization, knowledge development, culture management) and the nature of its relationship to tax pioneer performance represented in its dimensions (strategic direction, leadership indicators, growth, renewal and modernization, efficiency, Effectiveness) The questionnaire was approved as a main tool in collecting data and information from the sample members in the General Authority of Taxes, which number (91) Who are on (M. General Manager, Division Director, Deputy Director, Senior Division Director, Deputy Director, Second Division, Division Officer, M. D

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Publication Date
Thu Dec 31 2020
Journal Name
Journal Of Accounting And Financial Studies ( Jafs )
The contribution of the Environmental Audit to achieving the Sustainability of the Environmental Balance in the Sudanese Business Environment
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This study tackles the contribution of the environmental audit in achieving the sustainability of the environmental balance in the Sudanese business environment. The study aimed at clarifying the role of environmental auditing in supporting sustainable development, and to recognize the role of environmental audit in urging businesses to abide by environmental protection. It also shows how effective the environmental audit reports are, in providing the reliable data for the concerned authorities, in order to use it in making the decisions that would help in the sustainability of the environmental balance. To achieve the goals of the study, a questionnaire was developed and distributed to the registered chartered accountants in Sud

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Publication Date
Wed Mar 29 2023
Journal Name
Journal Of The College Of Education For Women
The Omani Sultanate of Zanzibar between Unity and Separation for the Period between (1223-1275 AH/ 1806-1861 A)
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Sultan Said bin Sultan bin Ahmed bin Said Al-Busaidi (1223-1273 AH / 1806-1856 AD) was able to rule Oman and Zanzibar in a unified Arab-African state during his reign. However, it was separated for several reasons. Thus, the study aims to clarify the efforts made by Sultan Said for annexing Zanzibar to Oman, establishing the Arab-African Sultanate, and shedding light on the role played by Britain in dividing the Arab-African Sultanate and separating Zanzibar from the Omani rule in (1275 AH-1861 AD). The study has adopted the historical descriptive analytical approach. The study has reached several conclusions, such as: The economic motivators  were the most important factors that pushed Sultan Said to move his capital from Muscat to

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Publication Date
Sat Jul 01 2023
Journal Name
Journal Of Accounting And Financial Studies ( Jafs )
Auditing the technical reserves of the aircraft body insurance branch and its reflection on the fairness of the financial statements : applied research in the National Insurance Company
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The research gained its importance from the importance of technical reserves in the insurance activity and its impact on the result of the activity of insurance companies and their financial position and thus reflected on the insurance prices as the technical reserves are one of the most important and most valuable budget items usually, as well as that the insurance activity has a role in maintaining economic development where some countries develop laws and instructions for the formation of those reserves binding application to insurance companies and the fact that the financial statements in general are of interest to shareholders, banks, the General Tax Authority and other beneficiaries In the insurance activity as policyholders and t

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Publication Date
Sun Nov 23 2025
Journal Name
Tikrit Journal Of Administrative And Economic sciences
Analyzing the relationship between human resource management practices and the creative behavior of employees Analytical research in the Ministry of Science and Technology
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Publication Date
Mon May 17 2021
Journal Name
Indian Journal Of Forensic Medicine &amp; Toxicology
The Effect of Exercises with a Proposed Device to Improving Some Bio-Kinematic Variables and the Performance of the Arab Round off Skill on Floor Movement Mat Device of the Artistic Gymnastics for Women
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The importance of the research lies in preparing exercises using a proposed device to learn the skill of thehuman wheel on a machine rug of ground movements of the artistic gymnastics. As for the research problem:Through the presence of the two researchers as teachers and observers of this sport in the gymnastics hall,they noticed that there is difficulty in the students’ performance of the skill of the round off on the machineof the mat of ground movements, according to the researchers’ opinion, the reason for this is that skillsare taught with the limited availability of assistive devices, as well as the lack of use of these devices inexercises according to biomechanical variables, although they facilitate the learning process

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