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All Journal The New Ropanasuri Journal of Surgery
Rachmawati, Asri D
Unknown Affiliation
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology

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Transanastomotic Feeding Tube in Surgical Management of Congenital Duodenal Obstruction: Case Series Gunardi, Hardian; Rachmawati, Asri D; Susilo, Nanok E; Tamba, Riana P
The New Ropanasuri Journal of Surgery Vol. 5, No. 2
Publisher : UI Scholars Hub

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Introduction. Prolonged fasting is a major concern in the postoperative management of congenital duodenal obstruction. Massive dilatation of the proximal segment would lead to diameter discrepancy and lack of propulsion, thus delaying enteral feeding. A transanastomotic feeding tube is an option to deliver early enteral feeding after surgical correction. The study evaluates the effectiveness and safety of a transanastomotic feeding tubes in the surgical management of congenital duodenal obstruction. Method. The transanastomotic feeding tube's effectiveness in cases of congenital duodenal obstruction of the newborn underwent surgical correction was evaluated. Those managed from January 2016 to December 2018 at dr. Cipto Mangunkusumo and Fatmawati General Hospital were subjected to the evaluation. Results. Ten cases were recorded, with the mean gestational age of 30.4 weeks (SD ± 2.12), with a mean bodyweight of 2.571 g (SD ± 392). Seventy percent of the cases accompanied by other anomalies. Enteral nutrition was introduced immediately after surgery. The median time of oral nutrition initiation was 13 days (3-21), and the patients were fully fed in 19.5 days (13-37). The average length of stay was 24.5 days (16-40 days). One case had a complication requiring surgery, and mortality in two cases complicated with sepsis. Conclusion: Transanastomotic feeding tube is an option to deliver early enteral feeding after surgical correction of congenital duodenal obstruction.
Anorectal Malformations in Monozygotic Twins: An Illustration of Management of Anorectal Malformations in A Tertiary Hospital in Indonesia Gunardi, Hardian; Rachmawati, Asri D; Susilo, Nanok E
The New Ropanasuri Journal of Surgery Vol. 6, No. 1
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A case of monozygotic twin boys with anorectal malformation with delayed presentation of bowel perforation. Both are managed surgically with a colostomy; after a definite diagnosis of anorectal malformation with a urethral fistula based on distal colostography, both boys underwent anoplasty with a posterior sagittal approach. Stoma closure was performed, and we found no complication during eight months of follow-up. Delay in the management of the twins was due to a lack of anal screening of the newborn. The unavailability of the neonatal intensive care unit became a significant concern. Distal colostography was performed for the definitive procedure. Despite that limitation, anorectoplasty was performed with a posterior sagittal approach. Anorectal malformations in twins are a rare case requiring thoughtful surgical care. A thorough understanding of the limitation of our resources could help in planning management for anorectal malformation, especially in twins.
Whipple Procedure for High-Grade Pediatric Pancreatic Injury After Blunt Trauma: A Case Report El Gah, David C; Rahayatri, Tri H; Rachmawati, Asri D; Nugroho, Adianto
The New Ropanasuri Journal of Surgery Vol. 10, No. 1
Publisher : UI Scholars Hub

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Introduction: Pediatric pancreatic injury isuncommon but carries significant morbidity. While non-operative management is standard for low-grade injuries, the optimal approach for high-grade trauma (AAST grade III–V) remains debated. Pancreaticoduodenectomy (Whipple procedure) is rarely performed due to high procedural risks and is typically reserved for severe pancreatic head injury with concomitant duodenal damage. Case presentations: A 13-year-old boy presented three days after blunt abdominal trauma with epigastric pain and bilious vomiting. CT imaging revealed free fluid, a large retroperitoneal hematoma, and suspected pancreatic head injury. Despite initial stability and conservative management in the High Care Unit, worsening abdominal distension prompted an exploratory laparotomy. Discussion: Surgery revealed pancreatic head laceration and duodenal tears. Consequently, a pancreaticoduodenectomy with pancreaticojejunostomy, choledochojejunostomy, and gastrojejunostomy wasperformed. The patient recovered steadily, resumed oral intake at two weeks, and was discharged in good condition. At the one-year follow-up, he remained asymptomatic and had resumed normal activities. Conclusion. This case demonstrates that pancreaticoduodenectomy is a definitive option for stable pediatric patients with high-grade pancreatic head and duodenal injuries when local reconstruction is unfeasible. However, due to its complexity, it should remain a last-resort strategy reserved for specialized hepatopancreatobiliary centers.
Co-Authors Adianto Nugroho El Gah, David C Gunardi, Hardian Rahayatri, Tri H Susilo, Nanok E Tamba, Riana P