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Department of Surgery, Faculty of Medicine, Universitas Indonesia RS dr. Cipto Mangunkusumo, Jakarta Jl. Diponegoro 71 Jakarta Pusat 10430, Indonesia
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INDONESIA
The New Ropanasuri Journal of Surgery
Published by Universitas Indonesia
ISSN : 25033328     EISSN : 25497871     DOI : 10.7454
Core Subject : Health, Science,
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology
The journal focused on general surgery with the scope of surgical research and surgery-related studies.
Arjuna Subject : Kedokteran - Pembedahan
Articles 107 Documents
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Surgical Research Taher, Akmal
The New Ropanasuri Journal of Surgery
Publisher : UI Scholars Hub

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Correlation between Obesity and Seroma Following Modified Radical Mastectomy Kurnia, Ahmad; Suhandi, Andri; Budiningsih, Setyawati
The New Ropanasuri Journal of Surgery
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Introduction. Obesity becomes one of concern for surgeon asit provides additional morbidity in breast cancer. It influencesthe healing process negatively, and increase the complications following mastectomy. The most often found complication is seroma. Its incidence in obese is found higher than non–obese patient. Studies evaluating the correlation between obesity and seroma showed controversy. Hence, we run a study aimed to find out such a correlation in our characteristics. Method.We conducted cross sectional study. All patients treated with modified radical mastectomy (MRM) during period of 2013 to 2014 were included. Subject characteristics were recorded, including age, body mass index (BMI). Bilateral breast malignancy, diabetes mellitus and hypertension were excluded.Drain production and infection, and length of staywas recorded. Kolmogorov Smirnov test is used to find out normal distribution. In normal distribution, Pearson test or Spearman’s is used to find out correlation. Results. Out of 72 samples underwent MRM and drainage, there were 67 enrolled. The mean age was found of 48.5±8.5 years, and mean BMI of 25.43 kg/m2 ± 4.08.Length of stay ranged of 3–8 days andmean total seroma production was found of 502.3mL ± 207.8. We foundmoderate positive linear correlation between obesity and seroma (r = 0.581; p <0.01; r2 = 0.338) rolled of 33.8% and strong positive linear correlation between seroma and length of stay (r = 0.581; p <0.01;r2 = 0.542)rolled of 52.4%. Conclusion. We found positive linear correlation between seroma and obesity, and positive linear correlation between seroma and length of stay
Evaluation of Local Advanced Breast Cancer Following Mastectomy: Recurrence and Influencing Clinicohistopathology Factors Yulian, Erwin D.; Yang, Andrew J.
The New Ropanasuri Journal of Surgery
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Introduction. Locally advanced breast cancer is a quite common clinical scenario in the developing countries where the recurrence remains a problem. Mastectomy is one of the primary treatment. Age, clinical stage, lymph nodes involvement, histopathlogy, tumorgrading and itssubtypes are thought as clinic histopathologic factors influencing the recurrence. We run a study aimed to find out role of these factors on the recurrence after mastectomy. Method. The study designed as an analytical cross–sectional one. A complete data of all patients treated in dr. Cipto Mangunkusumo General Hospital with locally advanced breast cancer underwentmastectomy withappropriate definitive treatmenttothe stage, and had disease free interval, and could be followed for at least 24 months during period of January 2011 to December 2012 is recorded. Results. There were 39 subjects enrolled. Among these subjects, the recurrence was 7.6%. Through bivariate analysis we found a significant correlation between the histopathology type (p = 0.008), lymph nodes involvement (p = 0.026) with the recurrence. In multivariate analysis we found that the most influential factor to reccurrence was lymph node involvement (p = 0.002). Conclusion. In this study the most influential factor on the recurrence in locally advanced breast cancer following mastectomy is positive lymph nodes more than three nodes.
Compliance of Patients with Locally Advanced Colorectal Cancer to Chemotherapy Using FOLFOX compared to XELOX Regimen Kusnadi, Dana S.; Putranto, Agi S.; Saunar, Rofi Y.; Kekalih, Aria; Moenadjat, Yefta
The New Ropanasuri Journal of Surgery
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Introduction. Adjuvant chemotherapy become the treatment of choice in advance colorectal cancer to prevent recurrence. Studies showed that FOLFOX and XELOX regimen has been proven to increase overall survival rate and disease free survival. This study is aimed to compare XELOX response to FOLFOX regimen in our center, which is characterized by advanced stage neoplasm in the first presentation with low compliance. It also aimed to find out affecting factors of such response. Method. We run a retrospective study enrolled of 133 subjects with colorectal carcinoma of stage III and high–risk stage II who received adjuvant chemotherapy and treated in dr. Cipto Mangunkusumo– and Fatmawati General Hospital. Consecutive sampling was instituted, CEA level and one year mortality rate was recorded as variables of the efficacy, which was then associated with subjects’ compliance. Statistical analysis was done using Chi square or Fisher test, and a multivariate logistic regression. Significance was found as the difference met <0.05 with confidence interval of 95%. Results. We found there is no significant difference between the two regimens with efficacy (p = 0.61). There is significant correlation between the regimen (p = 0.001 and 0.000); with compliance is found much higher in FOLFOX (86% compared to 45%). We also found statistically significant of influencing factors the efficacy, i.e. Karnofsky score >90 (OR = 5.8; p = 0.004), body mass index both of normal and more (OR = 4.7; p = 0.006), and with histopathologic grading of moderate differentiated (OR = 6.3; p = 0.003). Conclusion. FOLFOX and XELOX regimen has been shown to have a same efficacy in response in our center. However, compliance showed a strong correlation to efficacy and FOLFOX regimen showed much higher rather than XELOX. Karnofsky score and body mass index should be subjects of consideration to increase the response of such adjuvant chemotherapy.
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
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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.
Comparison of Japanese Classification with the TNM System in the Assessment of Staging in Sigmoid and Rectal Cancer Patients at dr. Cipto Mangunkusumo and Fatmawati General Hospital: A Preliminary Study Putranto, Agi S.; Kristianto, Yusak; Wangge, Grace
The New Ropanasuri Journal of Surgery
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Introduction. Lymph node metastasis of colorectal cancer is an independent prognostic factor and used as a guideline for adjuvant therapy. Paralleled to this, TNM staging system has been used widely and nowadays referred to a gold standard of colorectal cancer staging. So far, such a system classifies the staging based on the numbers of positive lymph node involvement. Japanese classification was another kind of system do that categorize based on the distribution of lymph nodes involved (i.e. paracolic/rectal, intermediate, root of mesenteric artery). Method. This was a preliminary study analyzed of 15 subjects with sigmoid and rectal cancer underwent surgery at dr. Cipto Mangunkusumo and Fatmawati General Hospital between September and October 2015. We studied the specimen for histopathological evaluation focused on the numbers of positive lymph nodes and the distribution of lymph node metastasis. Staging was carried out using both of TNM system and Japanese classification, and these variables were subjected to agreement analysis. Results. We found more than twelve lymph nodes from each sample. Based on TNM staging system, there are seven subjects on stage II, three subjects with stage IIIb and five subjects with stage IIIc, meanwhile based on Japanese Classification, there were seven subjects with stage II, one subjects with stage IIIa and seven subjects with stage IIIb. Analysis of agreement between both of classifications resulted in coefficient Kappa of 49.3% (moderate category) with p-value of 0.04. Conclusion. Our preliminary study showed that agreement between both of classifications to specify sigmoid and rectal staging is in moderate category. Japanese classification is feasible to be used. Agreement accuracy may be obtained with a bigger sample.
Implementation of revised Baux Score to Predict Mortality Burn Injured Patients in Burn Unit of dr. Cipto Mangunkusumo General Hospital, Jakarta Wardhana, Aditya; Mulyantara, Irwan; Kekalih, Aria
The New Ropanasuri Journal of Surgery
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Introduction. Implementation of stratification in burn injured patients referred to a very helpful approach for surgeon distinguishing severity of problems as well as predicting the outcome and lead a surgeon to make an accurate decision and a guidance to deliver patient’s condition to his/her family. A stratification tools for prediction should be simple and applicable in clinical setting. It also feasible to be applied for clinical use, research purpose, and system audit. Amongst scoring systems in burn surgery, revised Baux score is the one. The study is aimed to run validation in our burn characteristics. Method. A study run to find out validation for revised Baux score, prior to its use for application in our setting. We run cohort study enrolled burn injured patient treated during period of January 2010 to December 2012, retrospectively. Total body surface area involved, age and inhalation injury referred to variables subjected to statistical analysis. Results. Out of 442 burn injured patient, there were 234 subjects included in the study. Statistical analysis using Hosmer and Lemeshow test addressed to evaluate calibration of scoring performance showed p value of p = 1 (> 0.05), and for its precision we found the performance of discrimination of r–Baux score showed the area under curve (AUC) of 0.87 (CI 95%; 0.825–0.915), showing a p value of <0.001, and sensitivity 77.9% and specificity 76.9%. Conclusion. On validation, revised Baux score provide a good performance and likely would provide a merit of its clinical application.
Factors Affecting the Success Rate of Kasai Portoenterostomy Sastiono, Sastiono; Maheranny, Marethania; Oswari, Hanifah
The New Ropanasuri Journal of Surgery
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Introduction. Surgical repositioning of biliary drainage to the intestine (jejunum) through an artificial fistula (portoenterostomy) following surgical removal of extrahepatic residual biliary duct in biliary atresia, which is first proposed by Kasai has never been evaluated in our center. Thus, we run a study aimed to find out the successrate. Method. We run a cohort study retrospectively enrolled subjects with biliary atresia consecutively. A review of histopathology was carried out, and focused on degree of fibrosis as well as cirrhosis. Obtained data were subjected to statistical analysis using Fischer test and logistic regression. Results. Out of 15 subjects enrolled in the study, we found successmanagement in five subjects based on three months of icteric free period. Using Fischer test, we found a significant correlation (p = 0.04) between degree of fibrosis and outcomes in 1-year period with relative risk of 4 (CI 95% 1.5–10.65). Conclusion. Affecting factors in successrate of portoenterostomy remains unclear; degree of fibrosis might be the one. Different center reports different outcome as the histopathology characteristics varies in different center.
Hemorrhoid: Pathophysiology and Surgical Management A Literature reviews Lalisang, Toar JM
The New Ropanasuri Journal of Surgery
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Qualitative Study on Endothelial Cell–to–cell–junction Disassembly in Severe Burn Injury Moenadjat, Yefta; Siregar, Nurjati C.; Wanandi, Septelia I.; Sadikin, Mohamad
The New Ropanasuri Journal of Surgery
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Introduction. Endothelial gap in severe burn injury remain a mystery. Capillary leaks possess its own characteristics, which is found in burned– and non–burned area. The gaps remain up to 10 post burned days or more. This is somehow representing the feature of systemic capillary leaks syndrome at the first date. VE–cadherin of adherens endothelial junction molecules known to be temporarily disassembled following thermal exposure, but there’s a question about reversibility. Question is also addressed to occludin of the tight junction molecules. We run a study to investigate these junction molecules. Method. We run an investigation to find out both molecules qualitatively descriptive on 30 burn patients enrolled, consist of 20 severe– and 10 of non–severe burn. Samples of moderate size vein taken from burned– and non–burned area were subjected to study of histomorphology and immunohistochemistry. Light microscopic study and polymerase chain reaction test were carried out to compare the features and its expression. Analysis is carried out to find the difference, specificity and sensitivity. Results. Samples took within the first 8 hours following ER presentation showed severely deteriorated endothelial lining and both ofVE–cadherin and occludin dissociation. This endothelial junction disassembly was found in both of burned– and non–burned area; both of severe– and non– severe burn as well. In burned area, mRNA expression of VE–cadherin found to be increased, as occludin decreased. In severe burned group, mRNA expression of VE–cadherin as well as occludin found to be increased. VE–cadherin synthesis was found to be earlier than occludin. Conclusion. Dissociation of both of endothelial cell–to–cell molecules junction show no differences between the two groups, and between burned– and non–burned areas.

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