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Managing Gallstone during Pregnancy Lalisang, Toar JM
Indonesian Journal of Obstetrics and Gynecology Volume. 1, No. 4, October 2013
Publisher : Indonesian Socety of Obstetrics and Gynecology

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Transient physiological changes in the biliary system during pregnancy increased the risk of gallbladder diseases. Nonoperative management of symptomatic cholelithiasis increases the risk of complications of biliary lithiasis, such as cholecystitis and empyema, while obstruction common bile duct stones with or without cholangitisb and biliary pancreatitis raise maternal mortality. Delay in definitive surgical treatment of biliary diseases during pregnancy increases the likelihood acute biliary pancreatitis which impact on preterm delivery until fetal lost. Laparoscopic cholesystectomy during pregnancy has advantages for the mother in that it speeds up her recovery, giving her less pain and facilitated natural birth without a cesarean section. On the fetus side, laparoscopic cholecystectomy is safe since it does not induce preterm delivery or abortion. Identification of gallbladder stone during pregnancy warrant a preventive laparoscopic cholesystectomy or endoscopic CBD exploration, both of which promise good outcomes. [Indones J Obstet Gynecol 2013; 1-4: 219-21] Keywords: adult choledochal cyst, biliary cyst, biliary dilatation, mixed type

Managing Gallstone during Pregnancy Lalisang, Toar JM
Indonesian Journal of Obstetrics and Gynecology Volume. 1, No. 4, October 2013
Publisher : Indonesian Socety of Obstetrics and Gynecology

Transient physiological changes in the biliary system during pregnancy increased the risk of gallbladder diseases. Nonoperative management of symptomatic cholelithiasis increases the risk of complications of biliary lithiasis, such as cholecystitis and empyema, while obstruction common bile duct stones with or without cholangitisb and biliary pancreatitis raise maternal mortality. Delay in definitive surgical treatment of biliary diseases during pregnancy increases the likelihood acute biliary pancreatitis which impact on preterm delivery until fetal lost. Laparoscopic cholesystectomy during pregnancy has advantages for the mother in that it speeds up her recovery, giving her less pain and facilitated natural birth without a cesarean section. On the fetus side, laparoscopic cholecystectomy is safe since it does not induce preterm delivery or abortion. Identification of gallbladder stone during pregnancy warrant a preventive laparoscopic cholesystectomy or endoscopic CBD exploration, both of which promise good outcomes. [Indones J Obstet Gynecol 2013; 1-4: 219-21] Keywords: adult choledochal cyst, biliary cyst, biliary dilatation, mixed type

Merit of APACHE II, MPI and ARPI scores as determinants On Demand Relaparotomy Kamil, Radhita F.; Lalisang, Toar JM; Kekalih, Aria
The New Ropanasuri Journal of Surgery
Publisher : UI Scholars Hub

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Introduction. Delayed in decision making to carry out relaparotomy increases the morbidity and mortality. The decision to be made on demand relaparotomy is a kind of one subjectivity on the clinical setting. Therefore, it is necessary to have a thorough physical examination with additional diagnostic tools as the rationale to make an accurate decision that is the scoring system. There were many scoring systems has been proposed, and we run a study aimed to find out the merit of those scoring. Method. We run a case-control study enrolled 32 subjects with on demand relaparotomy and 64 subjects with laparotomy for any indication. APACHE II, MPI, ARPI scores were applied as variables. Data collected retrospectively from those who underwent laparotomy andrelaparotomy in RS dr.Cipto Mangunkusumo General Hospital in period of January 2012 to December 2013. These variables subjected to statistical analysis. Results. Based on statistical analysis of the two groups we found that APACHE II showed no significant difference (p = 0.114), whilst MPI and ARPI showed significant difference (p <0.0001). ROC curve showed that APACHE II had AUC of 59.2% with a cut-off point of 10, MPI had AUC of 86.4% with a cut-off point of 20 and ARPI had AUC of 77.6% with a cut-off point of 10. Conclusion. MPI and ARPI could be used as determinants on demand relaparotomy.

Hemorrhoid: Pathophysiology and Surgical Management A Literature reviews Lalisang, Toar JM
The New Ropanasuri Journal of Surgery
Publisher : UI Scholars Hub

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How early is early…? The Role of Abdominal Reoperation Predictive Index at dr. Cipto Mangunkusumo General Hospital, Jakarta Marbun, Vania MG; Lalisang, Toar JM
The New Ropanasuri Journal of Surgery
Publisher : UI Scholars Hub

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Introduction. Determining the right timing of relaparotomy has always been a challenge and hence a simple objective value is required. Abdominal reoperative predictive index (ARPI) proposed to decide when to reoperate. The study aimed to ascertain whether ARPI could be applied in decision making for relaparotomy at dr.Cipto Mangunkusumo General Hospital (RSCM), Jakarta. Method. A cross sectional study carried out on those underwent relaparotomy in Department of Surgery at RSCM during period of 2009–2015. The follow–up carried out by the residents under supervision of attending surgeons, the laboratory findings were reviewed and tabulated in accordance with clinical variables of ARPI. Eight variables of ARPI were reviewed in these subjects. Results. There were 30 subjects reviewed. In this study there were four frequent variables, i.e. persistent symptoms (for more than 4 days after relaparotomy), abdominal pain (that remains for 48 hours after relaparotomy), surgical site infection (90%), and ileus (70%). Seventy–three–point three percent carried out in more than 7 days after primary operation, while as only 10 percent underwent relaparotomy less than 4 days after primary operation. Conclusion. ARPI is practical guide and may be implemented in helping surgeons to decide relaparotomy should there required. Low compliance lead to delay in the management and associated with high mortality.

Gallstone Ileus in Cipto Mangunkusumo General Hospital, Jakarta: A Case Series Lalisang, Toar JM; Hehuwat, Georgina P.; Lalisang, Arnetta NL; Pratama, Irfan K.; Mazni, Yarman
The New Ropanasuri Journal of Surgery
Publisher : UI Scholars Hub

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Introduction. Gallstone ileus is an uncommon mechanical bowel obstruction caused by a gallstone in the gastrointestinal tract which enters due to bile-enteric fistulae. This study aims to describe gallstone ileus and its management. Method. Data were retrospectively collected from medical records. Clinical manifestations, laboratory data, supporting radiographic examinations, treatment, postoperative care, and outcomes were collected. Results. We report two gallstone ileus cases at Cipto Mangunkusumo General Hospital, Jakarta which admitted in the last 20 years. The first case was a woman 33 years in 2002 and the second was man 45 years in 2017. Ileus was the main clinical symptoms. Gallstone ileus was diagnosed with preoperatively based on clinical and radiology findings. Laparotomy was performed and ileostomy for stones evacuation and cholecystectomy were performed without bile-enteric fistula repair. Large black stones were found at terminal ileum which made the obstruction. Conclusion. Gallstone ileus was an uncommon disease which can be treated and has a good prognosis. Plain abdominal x-ray has an important role in diagnosis and treatment approach.

Availability and Distribution of Stoma Bags for Colorectal Cancer Patients: A Case Study at National Referral and Private Hospitals Aryani, Ratna; Lalisang, Toar JM; Dahlia, Debie; Martha, Evi; Hamid, Achir Yani S; Wicaturatmashudi, Sukma; Helen, Helen
Kesmas Vol. 20, No. 2
Publisher : UI Scholars Hub

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Stoma bags are essential for colorectal cancer (CRC) patients with stomas. However, access and affordability in Indonesia remain challenging as the National Health Insurance (NHI) does not fully cover these devices. This study aimed to describe the availability and distribution of stoma bags for patients with CRC in national referral and private hospitals, focusing on outpatient access. A qualitative case study was conducted through observations and in-depth interviews with four enterostomal therapy nurses and six patients across three national referral hospitals and one private hospital in the Jakarta Metropolitan Area, Indonesia. Notably, the availability of stoma bags was limited in both hospital types, especially for outpatients. Most patients faced financial barriers, as they had to purchase stoma bags independently at high prices because of limited hospital supply and lack of NHI coverage. Moreover, hospital policies restricted the number of bags distributed, worsening access issues. These challenges increase stoma-related complication risk and negatively affect patients’ quality of life. Integrating stoma bags into NHI coverage, regulating prices, and improving distribution are recommended to reduce healthcare disparities and improve outcomes for CRC patients, aligning with Sustainable Development Goal 3.

Self-management intervention model for optimizing psychological well-being in patients with colorectal stoma Aryani, Ratna; Lalisang, Toar JM; Dahlia, Debie; Martha, Evi
Jurnal Konseling dan Pendidikan Vol. 11 No. 4 (2023): JKP
Publisher : Indonesian Institute for Counseling, Education and Therapy (IICET)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.29210/1105700

A stoma can increase life expectancy and support health recovery but brings several physical and psychosocial issues. Psychosocial resilience is critical in dealing with these changes. This study aims to provide new insights into the interaction between self-management and psychosocial resilience in colorectal cancer stoma patients. This research employs a qualitative design with a case study approach. The study involves colorectal cancer patients with completed primary cancer-related therapies, totaling eight individuals. The informants also include family members of the patients (eight individuals) and volunteer nurses within the community (three individuals). The research instrument is an interview guide structured around five themes. Data analysis follows qualitative stages, encompassing reduction, presentation, and conclusion. Triangulation techniques are utilized to ensure the validity of the findings. The findings suggest that collaboration between family, community, and nurses can provide comprehensive support. However, a structured and focused self-management intervention model is needed to improve psychosocial consistency and resilience. Three models were proposed, namely Family Therapy, Online Community Support, and Nurse Integration in Self-Management, hoping to provide more specific guidance and support for patients. This study provides a basis for developing more varied intervention models and a comprehensive understanding of self-management of colorectal cancer stoma patients.

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