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All Journal BALI MEDICAL JOURNAL (BMJ) Majalah Kedokteran Bandung Jurnal Pendidikan Kedokteran Indonesia: The Indonesian Journal of Medical Education Medica Hospitalia Medika Kartika : Jurnal Kedokteran dan Kesehatan Journal of the Indonesian Medical Association : Majalah Kedokteran Indonesia Jurnal Ilmu Bedah Indonesia
Reno Rudiman
Consultant Digestive Division of Surgery Department, Faculty of Medicine, University of Padjadjaran Dr. Hasan Sadikin Hospital - Bandung Indonesia.
Biochemistry, Genetics & Molecular Biology Dentistry Education Health Professions Immunology & microbiology Medicine & Pharmacology Nursing Public Health Veterinary

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SURGICAL EDUCATION AND TRAINING ADAPTATION IN RESPONSE TO THE COVID-19 PANDEMIC: A LITERATURE REVIEW Rudiman, Reno; Hapsari, Putie
Jurnal Pendidikan Kedokteran Indonesia: The Indonesian Journal of Medical Education Vol 12, No 3 (2023): September
Publisher : Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jpki.76235

Abstract

Background: As a global health emergency, the COVID-19 pandemic has affected all medical education and training, including surgical specialities. The number of elective surgeries dropped significantly as both an impact of the pandemic and a way of limiting the spread of the disease. There was confusion about continuing surgical education and training at the beginning of the pandemic. However, as the pandemic continued, we adapted to the new conditions and regulations. Social distancing, testing, and quarantine were promoted. The study aimed to show how surgical education and training adapt to the COVID-19 pandemic worldwide and share how we do it in Indonesia.Methods: The authors gathered relevant literature from several publications sites, using the keywords “surgical education,” “surgical adaptation,” and “COVID-19.”Results: In order to decrease contacts, the number of people in the operating room was reduced, clinical rounds were cancelled, and face-to-face training and lectures were moved to online platforms, namely Zoom and Google Meet. The number of residents on clinical duties was decreased to limit the transmission. They are encouraged to study using different models by themselves to keep up with the required skills. They were required to learn and then be tested or reviewed by the supervisor. The use of simulation models and online learning platforms provided by several worldwide institutions has become popular.Conclusion: We learn that surgical education and training from the pandemic can develop into a more modern way of learning, consisting of a virtual learning strategy and simulation model. This hybrid learning of offline and online courses can aid the growth of not only the residents but also the experienced surgeon.
Lactic Acid Level as A Predictor of Severity in Patients with Acute Appendicitis Aditya, Raka; Rudiman, Reno; Hapsari, Putie
Majalah Kedokteran Bandung Vol 56, No 1 (2024)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15395/mkb.v56.3086

Abstract

Perforated appendicitis is the leading cause of morbidity and mortality of all appendicitis cases in adults and children, with delayed preoperative diagnosis as the main reason. In previous studies, diagnostic modalities such as radiological examination and the current scoring system have been demonstrated as unable to predict the onset of perforated appendicitis. Serological biomarkers of lactic acid are associated with intestinal obstruction and ischemia. The serological value of lactic acid in identifying perforated appendicitis compared to acute one was shown to increase significantly by 0.25 mmol/L (p<0.05) in a previous study. This study aimed to determine the correlation between lactic acid and the severity of appendicitis. This was a cross-sectional prospective analytic observational study in patients treated in Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. Subjects were adult patients diagnosed with appendicitis during the period of 2021 in the Emergency Room of the hospital. Data were analyzed using the bivariate analysis and correlation test of difference. This study involved 54 subjects, divided into the complicated appendicitis (study) and control groups, with a mean of lactic acid level of 2,5093 mmol/L (0.9 mmol/L–11.8 mmol/L). In the complicated appendicitis group, 20 subjects (37%) demonstrated an increase in lactic acid level (OR 1.07; 95% CI: -0.03–0.22; p=0.14). The correlation analysis resulted in a negative correlation. This study concluded that there is no significant correlation between lactic acid levels and the severity of appendicitis in these patients.
Vitamin D Supplementation and Colorectal Cancer Patients Outcomes Mulyadi, Noeray Pratiwi; Rudiman, Reno; Purnama, Andriana
Majalah Kedokteran Bandung Vol 56, No 4 (2024)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15395/mkb.v56.3823

Abstract

Colorectal cancer is the third most encountered malignancy worldwide in 2018. Some earlier studies indicate a significant influence of vitamin D supplementation on the 5-year survival rate and the rate of metastasis progression in colorectal cancer patients. Studies investigating the effects of vitamin D supplementation on the outcomes of colorectal cancer patients are limited in Indonesia. Therefore, a double-blinded Randomized Controlled Trial (RCT) of the effect of vitamin D supplementation on the outcome of colorectal cancer patients was conducted from April 2022 to March 2023 at the digestive surgery outpatient clinic of Dr. Hasan Sadikin General Hospital Bandung, Indonesia. In this study, 36 patients received vitamin D and 34 patients received a placebo. Data analysis performed using the multivariate analysis with multiple regression revealed no significant relationship between vitamin D supplementation and colorectal cancer patient outcomes. Furthermore, ANOVA analysis indicated no relationship between the analyzed independent and dependent variables in this study.  No relationship was found between vitamin D supplementation and the outcomes of metastasis, mortality, and Karnofsky scores in colorectal cancer patients. Further research with a larger population is still needed to determine the benefits of vitamin D supplementation on the outcomes of colorectal cancer patients.
Konsensus Perhimpunan Dokter Spesialis Bedah Digestif Indonesia tentang Pedoman Diagnosis dan Tatalaksana Batu Saluran Empedu Rivai, Muhammad Iqbal; Lalisang, Arnetta Naomi Louise; Nugroho, Adianto; Wibowo, Agung Ary; Handaya, Adeodatus Yuda; Arifin, Fransiscus; Situmorang, Indah; Prabowo, Erik; Irwan, Irwan; Mayasari, Maria; Tendean, Michael; Rudiman, Reno; Setyadi, Kunsemedi; Niam, Muhammad Shobachun; Suprapto, Bambang; Putra, Jeffri; Lesmana, Tommy; Mazni, Yarman; Muhar, Adi Muradi; Mulyawan, I Made; Warsinggih, Warsinggih; Lalisang, Toar Jean Maurice
Majalah Kedokteran Indonesia Vol 74 No 2 (2024): Journal of The Indonesian Medical Association - Majalah Kedokteran Indonesia, Vo
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47830/jinma-vol.74.2-2024-1188

Abstract

Introduction: Choledocholithiasis, the presence of stones in the common bile duct (CBD), is a challenge in the field of digestive surgery due to the wide range of cases with varying levels of difficulty. Until now, the options for diagnostic and therapeutic modalities have been increasingly evolving, ranging from non-invasive to invasive procedures. Therefore, the Indonesian Society of Digestive Surgeons provides recommendations for the management of CBD stone cases in Indonesia.Method: The consensus was developed using the Delphi survey method involving digestive surgery experts from various cities in Indonesia. Several issues related to the diagnosis and management of CBD stones were formulated and answered based on current research, while also considering the opinions of the experts.Result: This consensus consists of two parts: 15 recommendations related to the selection of diagnostic modalities and 10 recommendations related to management options. Recommendations regarding diagnosis include the use of ultrasonography, abdominal CT-scan, and magnetic resonance cholangiopancreatography (MRCP). In addition to standard therapeutic procedures, this consensus also provides recommendations regarding contemporary procedures such as endoscopic retrograde cholangiopancreatography (ERCP), laparoscopic common bile duct exploration (LCBDE), and open common bile duct exploration (OCBDE).Conclusion: These recommendations are aimed to assist digestive surgery experts in providing the best management for CBD stone cases.
Comparison of CONUT Score, SGA Score, and GLIM Score as Gold Standard for Colorectal Cancer Patients Marcella, Marcella; Rudiman, Reno; Yohana, Raden
Majalah Kedokteran Bandung Vol 57, No 1 (2025)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15395/mkb.v57.3846

Abstract

Malnutrition in colorectal cancer increases toxicity, worsens quality of life, and reduces body functions. Early identification of malnutrition is crucial to determine treatments. This study compared the Global Leadership Initiative on Malnutrition (GLIM) score as the standard nutritional status screening tool to the Controlling Nutritional Status (CONUT) and Subjective Global Assessment (SGA) scores. This study expected to identify a new nutritional status screening tool for colorectal cancer patients. This was a cross-sectional diagnostic study on 60 colorectal cancer patients treated at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia from August 16, 2022 to July 16, 2023. Results revealed that the CONUT score had a sensitivity, specificity, accuracy, and effectiveness values of 80.4%, 0.0%, 85%, and 85%, respectively, in detecting malnutrition. The SGA score had a sensitivity value of 100%, a specificity value of 21.95%, an accuracy value of 85%, and an effectiveness of 85% in detecting malnutrition. When compared with the GLIM score as the gold standard, which is assumed to have a sensitivity and specificity values of 100%, the SGA score was better than the CONUT score for detecting malnutrition in colorectal cancer patients. The SGA score is closest to the GLIM score as the gold standard for assessing malnutrition in colorectal cancer patients.
Correlation Between ERCP Implementation Time and Outcomes of Patients with Acute Cholangitis Due to Choledocholithiasis Ayundra, Muhammad Hilmy; Rudiman, Reno; Hapsari, Putie
Majalah Kedokteran Bandung Vol 57, No 2 (2025)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15395/mkb.v57.3965

Abstract

Acute cholangitis is a serious condition, and timely ERCP is essential for effective management. This prospective cohort study was conducted at Dr. Hasan Sadikin Hospital in Bandung, Indonesia, from June 2023 to April 2024, to evaluate the feasibility of performing ERCP beyond 48 hours in the presence of various limitations. The study included patients with acute cholangitis caused by common bile duct stones. The ERCP timing was categorized into three groups: less than 48 hours, 48-72 hours, and more than 72 hours. Outcomes measured were hospital stay duration, ICU admission, and 30-day mortality. Of these patients, 52.8% underwent ERCP at 48-72 hours, 27.8% after 72 hours, and 19.4% before 48 hours. The median hospital stay was 7.5 days (IQR 3-15). ICU admissions occurred only in patients receiving ERCP after 72 hours (30.0%), a significantly higher rate compared to the other groups (p=0.014). A strong correlation was found between delayed ERCP and longer hospital stays (r=0.711, p<0.01), as well as ICU admission (r=0.405, p=0.014), though no significant correlation with mortality was observed (r=-0.021, p=0.905).
Comparison of Sensitivity and Specificity between B.I.L.E. Criteria and Tokyo Guidelines 2018 (TG18) for Diagnosing Acute Cholangitis Pratomo, Nugroho Rizky; Rudiman, Reno; Sulthana, Bambang Am am Setya
Majalah Kedokteran Bandung Vol 57, No 3 (2025)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15395/mkb.v57.4132

Abstract

Acute cholangitis is an inflammatory condition of the biliary system due to bacterial infection associated with biliary stasis or obstruction. Diagnosis is made using the Tokyo Guidelines 2018 (TG18) criteria. The biliary imaging abnormality, inflammatory test abnormality, liver test abnormality, and exclusion of cholecystitis/pancreatitis (B.I.L.E.) criteria are relatively new, with limited studies evaluating their sensitivity, specificity, and validation. This study aimed to compare the sensitivity and specificity of B.I.L.E. and TG18 criteria for the diagnosis of acute cholangitis. This is an observational analytic study with prospective cohort design during May 2023–May 2024. Data were obtained from patients who came to the Emergency Department of Dr. Hasan Sadikin General Hospital Bandung, Indonesia, with clinical symptoms of fever and jaundice, suspected of acute cholangitis. There were 95 subjects in this study. Based on B.I.L.E. criteria, 57 (60%) patients were categorized as high probability and 38 (40%) patients were categorized as unlikely acute cholangitis, while the TG18 criteria resulted in 61 (64.2%) patients classified as definite and 34 (35.8%) patients classified as suspected acute cholangitis. The sensitivity of the B.I.L.E. criteria was 92.1%, with a specificity of 94.73%. Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of B.I.L.E. criteria were 92.1% and 94.73%, respectively. In contrast, the sensitivity and specificity of TG18 criteria in this study were 82.35% and 83.6%, respectively. The PPV of TG18 reached 73.68% while the NPV of TG18 reached 89.47%. In conclusion, B.I.L.E. criteria have higher sensitivity and specificity than TG18 criteria in diagnosing acute cholangitis patients.
Co-Authors Abdul Mughni Adeodatus Yuda Handaya Adianto Nugroho Aditya, Raka Agung Ary Wibowo, Agung Ary Akhsan, Alfie Barkah Andriana Purnama, Andriana Ayundra, Muhammad Hilmy Barr, Tubagus Izzul Edwin Saleh Siregar, Edwin Saleh Fransiscus Arifin Hapsari, Putie Harry Galuh Nugraha Ignatius Riwanto, Ignatius Indah Situmorang Irwan Irwan Kiki Lukman Lalisang, Arnetta Naomi Louise Lalisang, Toar Jean Maurice Lesmana, Tommy Marcella, Marcella Maria Mayasari Mazni, Yarman Muhar, Adi Muradi Mulyadi, Noeray Pratiwi Mulyawan, I Made Niam, Muhammad Shobachun Nugrahadi, Dimas Erlangga Octoria, Nova Prabowo, Erik Pratomo, Nugroho Rizky Putra, Jeffri Raden Yohana, Raden Renata, Bella Rivai, Muhammad Iqbal Rizky, Kiki A Rodjak, Maman Wastaman Setyadi, Kunsemedi Silalahi, Fonda R.P Singarimbun, Wilner Stevanus, Hendrik Sulistyanti, Raden Lyana Sulthana, Bambang Am am Setya Suprapto, Bambang Suraya Adnyana, Ida Bagus Budhi Tendean, Michael Tjokorda Gde Dalem Pemayun Usman, Nurhayat Warsinggih, Warsinggih