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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 May 20 2008
Journal Name
Journal Of Planner And Development
The use of mathematical formulas to control river pollution Study area Diyala River within the city of Baquba
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Pollution of the aquatic environment and the depletion of the natural resource cause imbalance in the natural balance of the river environment and contributes to the deterioration of life and the killing of living organisms. Most of the old and modern cities and urban centers were set up close to the rivers because water enters the main lifeblood and all its facilities. The proximity of cities to rivers caused environmental problems resulting from the dumping of residues of these cities to a large and continuous, these wastes include all uses of the city (industrial, agricultural, residential and commercial) and others. The accumulation of these wastes inside the rivers water kills life and makes them unsuitable for various uses to bury

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Publication Date
Fri Jan 01 2021
Journal Name
Journal Of Accounting And Financial Studies ( Jafs )
The effect of marketing vigilance in attracting deposits: Applied research in a sample of private commercial bank
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The aim of the research is to demonstrate the impact of the dimensions of the marketing vigilance represented by (environmental scanning, diagnostic capacity, validity and decision-making) and to attract deposits represented by (customer relationship management strategy, distribution strategy (location), promotion strategy), as the research was applied in each of Banks (Assyria International, Iraqi Middle East Investment, Business Bay, Iraqi Investment, Babel, Al Mansour Investment), and the questionnaire was adopted as a main tool for collecting data and information from a sample of (110) who are in the position (department manager, department manager, assistant Section Director, Division Officer, Unit Officer), and the statistical prog

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Publication Date
Tue Dec 01 2015
Journal Name
Journal Of Economics And Administrative Sciences
Factors Influencing the Establishment of Investment Portfolios ((Analytical Research in a number of Private Banks in Baghdad))
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       The investment portfolio of financial instruments & banking relatively new in the banking sector & the world of investment &capital markets in spite of its importance & its advantages in terms of the nature of the diversity of investment instruments as well as reduce the risk of investment & its contribution to the revitalization of the banks & the financial market , economic,  &characterized by developments accelerated under information & communications technology , as is the portfolio tool vehicle of investment tools that provide for people who want to invest & they can not manag

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Publication Date
Wed Mar 29 2017
Journal Name
Iraqi Journal Of Pharmaceutical Sciences ( P-issn 1683 - 3597 E-issn 2521 - 3512)
The Prevalence of Microorganisms in H1N1 Patients Compared to Seasonal Influenza in a Sample of Iraqi Patients
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This study provides valuable information on secondary microbial infections in H1N1 patients compared to Seasonal Influenza in Iraqi Patients. Nasopharynx  swabs were collected from  (12 ) patients  infected with Seasonal influenza (11  from Baghdad  and 1 Patient from south of Iraq) ,and ( 22 ) samples from patients with 2009 H1N1 ( 20 from Baghdad and  2 from  south of Iraq). The results show that the patients infected with 2009 H1N1 Virus were younger than healthy subjects and those infected with seasonal influenza. And the difference reached to the level of significance     (p< 0.01) compared with healthy subjects.Two cases infected with 2009 H1N1 virus (9.1%) were fro

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Publication Date
Fri Aug 22 2025
Journal Name
Frontiers In Political Science
The role of identity in a multilevel interdependence in international relations: exploring popular understandings of international politics
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This study investigates the role of identity as a critical factor in mediating the relationship between local and regional politics within the broader context of international relations (IR). While identity is frequently acknowledged as a catalyst for political instability and conflict, its function in fostering interdependence across political levels remains underexplored, particularly through empirical research. To address this gap, the study adopts a quantitative methodology, drawing on theories of identity politics and interdependence. A structured survey was administered to assess public perceptions of identity's influence on international engagement and its bridging role between domestic and regional political dynamics. The fi

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Publication Date
Tue Sep 07 2021
Journal Name
Nanomaterials
Transformation of Silver Nanoparticles (AgNPs) during Lime Treatment of Wastewater Sludge and Their Impact on Soil Bacteria
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This study investigated the impact of lime stabilization on the fate and transformation of AgNPs. It also evaluated the changes in the population and diversity of the five most relevant bacterial phyla in soil after applying lime-stabilized sludge containing AgNPs. The study was performed by spiking an environmentally relevant concentration of AgNPs (2 mg AgNPs/g TS) in sludge, applying lime stabilization to increase pH to above 12 for two hours, and applying lime-treated sludge to soil samples. Transmission electron microscopy (TEM) and energy-dispersive X-ray spectroscopy (EDS) were used to investigate the morphological and compositional changes of AgNPs during lime stabilization. After the application of lime stabilized sludge to

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Publication Date
Tue Feb 18 2020
Journal Name
Modelling And Simulation In Engineering
Temperature and Stress Evaluation during Three Different Phases of Friction Stir Welding of AA 7075-T651 Alloy
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The current study performs an explicit nonlinear finite element simulation to predict temperature distribution and consequent stresses during the friction stir welding (FSW) of AA 7075-T651 alloy. The ABAQUS® finite element software was used to model and analyze the process steps that involve plunging, dwelling, and traverse stages. Techniques such as Arbitrary Lagrangian–Eulerian (ALE) formulation, adaptive meshing, and computational feature of mass scaling were utilized to simulate sequence events during the friction stir welding process. The contact between the welding tool and workpiece was modelled through applying Coulomb’s friction model with a nonlinear friction coefficient value. Also, the model considered the effect of nonlin

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Publication Date
Mon Jan 01 2018
Journal Name
Journal Of The College Of Languages (jcl)
Analysis of the symbolic images in the work of Mexican theater of: "all cats are brown," the writer Carlos Fuentes and "Palinuro on the stairs," the writer Fernando del Paso
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 This article briefly analyzing contemporary works appeared in theater writer from Latin America, which comes within the theme of "power." Latin American Literature, such as two-way extremely clear: the vanguard of social and attention, have arrived at certain moments to some extent be regarded as a two-way rival. That desire to participate in the revolution of expression and artistic significance, has appeared evident in the literature of Latin America in the late nineteenth century and ended in the third decade of the twentieth century. The writers that stage would prefer not to serve the objectives of the revolution of Arts own but the objectives of social and political revolution that stimulate the world. These acts were issued

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Publication Date
Sun Dec 12 2010
Journal Name
Journal Of Planner And Development
The stage of change and institution-building and its impact on the structure of housing policy in Iraq
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The research examines the reality of the housing sector in Iraq and the stage of change and institution-building, which is increasingly challenging to respond to development needs. The legal legislation in Iraq over the last five years indicates a significant shift towards decentralization, with powers and services being delegated from federal ministries to regional levels Localization and growth in cities and urban centers is an added factor that requires responses from local governments to strengthen the capacity of their institutions to engage in national policy debate at the re
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Publication Date
Wed Jan 30 2013
Journal Name
Al-kindy College Medical Journal
The efficacy and tolerability of 10mg and 20mg/day isotretinoinin the treatment of acne vulgaris in Iraqi patients
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Back ground: Oral isotretinoin is recommended
for sever nodulocystic acne in the doses 0.5-
2mg/kg/day which is usually associated with higher
incidence of adverse effects. To reduce the
incidence of side-effects and to make it more costeffective,
the lower dose regimen of isotretinoin has
been used.
Aim: To compare the efficacy and tolerability of
oral isotretinoin 10mg and 20mg/day in acne
vulgaris.
Methods: one hundred and twenty patients with
acne vulgaris were randomized into two treatment
regimens each consisting of 60 patients. The first
was treated with 10mg/day and the second group
with 20mg/day for 24 weeks. Fifty five patients
from the first group and 47 patients from the second

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