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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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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 11 Documents
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Search results for , issue "vol. 3, no. 2" : 11 Documents clear
Triple Diagnostic Accuracy on Early Stage Breast Cancer at dr. Cipto Mangunkusumo and Persahabatan General Hospital Kartini, Diani; Megatia, Ika; Darmiati, Sawitri; Rustamadji, Primariadewi; Budiningsih, Setyawati
The New Ropanasuri Journal of Surgery Vol. 3, No. 2
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Abstract

Introduction. Breast cancer is the most common cancer in Indonesia with incidence rate 40.3 per 100.000 women and mortality rate 16.6 per 100.000women. On early stage, the decision for operative procedure (i.e. mastectomy) requires intraoperative frozen section to assess malignancy; which is mostly unavailable in secondary hospitals. The triple diagnostic (TD) test consists of physical examination, breast ultrasonography and fine needle aspiration biopsy is an accurate and simple preoperative diagnostic method that may solve the problem. The study aimed to find out conformance of the triple diagnostic to histopathology findings in those with breast lump where the malignancy was suspected. Method. A study of diagnostic accuracy conducted enrolling subjects with suspected malignant breast lump managed in dr Cipto Mangunkusumo General Hospital (RSCM) and Persahabatan Hospital (RSP) in period of February 2016 to August 2017 who met the criteria: those underwent preoperative triple diagnostic, intraoperative frozen section and histopathology examination. The conformance of TD and frozen section were compared to histopathology findings. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were the focuses of the study. Results. There were 33 subjects enrolled (prevalence of 4.3%), mean age of 49.6 years ± 10.9, were above 40 years (78.8%). Tumor size of 2–5 cm found in 63.6% subjects, and the most histopathology finding was invasive carcinoma (84.8%). Frozen section showed sensitivity of 96.8%, specificity of 100%, PPV of 100%, NPV of 66.7% and accuracy of 97.0%. TD showed sensitivity of 77.4%, specificity of 100%, PPV of 100%), NPV of 22.2% and accuracy of 78.8% (p = 0.016). Conclusion. Triple diagnostic reaches up to 78% accuracy on early stage breast cancer may be used secondary hospital in Indonesia whenever frozen section is unavailable.
CT Scan as A Diagnostic Modality of Gastrointestinal Stromal Tumor: A Systematic Review Mazni, Yarman; Robby, Rizky DK
The New Ropanasuri Journal of Surgery Vol. 3, No. 2
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Introduction. Preoperative diagnosis of GIST is an important factor in the management. However, due to the rarity of the case, there is a controversy about the accuracy of CT scan as an accurate diagnostic tool. Therefore, a systematic review is required to find out the answer. Method. A review was conducted to find out evidence of the highest level regarding the accuracy of CT scan as a diagnostic modality of GIST. The study addressed to find out the sensitivity, specificity, positive and negative predictive values. A literature search carried out in database sites i.e. PubMed, ClinicalKey, ScienceDirect, and Cochrane using keywords “gastrointestinal stromal tumor” OR “GIST” AND “ultrasound” OR “CT scan” OR “MRI” AND “diagnostic” OR “imaging”. Systematic reviews, RCTs, cohort study, case report or series, studies in adults, published within the last ten years, and availability in full text were included. Correspondence, editorial, or commentary, and no histopathology data were excluded. The articles were critically appraised. The review proceeded in accordance with PRISMA. Results. Twelve studies were analyzed in the study. The sensitivity of CT scan was in range of 77.26–94.9%, specificity 77.2–100%, PPV 74.38– 100%, and NPV 68.32–81.2%. CT scan was found to be the modality of choice in establishing the diagnosis of GIST. Central necrosis, heterogenous enhancement, cavitation without lymphadenopathy were the features represented by CT scan. Conclusion. CT scan is the modality of choice in establishing diagnosis of uncomplicated GIST, with sensitivity and specificity of 94.9% and 100%, respectively. Other modalities were considered in advanced or GIST with metastasis.
Laparoscopic Approach in Correction of Adult Diaphragmatic Morgagni Hernia Mazni, Yarman; Prabowo, Andrio W
The New Ropanasuri Journal of Surgery Vol. 3, No. 2
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Introduction. Adult diaphragmatic hernia of Morgagni is a very rare congenital anomaly. Therefore, to date there is no standard surgical techniques used in the management. Thus, a systematic review aimed to find the highest evidence in the management. Method. A systematic review conducted in accordance with PRISMA. Literature search proceeded on PubMed and ScienceDirect using keywords "diaphragmatic hernia of Morgagni in adult", and "treatment". These articles were reviewed and appraised for the study design used, enrolled samples, validation of results, etc. to find out the level of evidence. The analysis was focused on length of stay, the recurrence, and complications. Results. There were 15 articles reviewed. The transabdominal approach provides better exposure, short length of stays, and low complications. Laparoscopic has been used widely and replaces open surgery. The defect closure using mesh is indicated in large defect of ≥20 cm2 . The hernial sac is unnecessary to resect, with no complication such as seroma or recurrence. Conclusion. A laparoscopic approach referred to the method of choice in the management of adult diaphragmatic hernia of Morgagni. Unnecessary resection of hernial sac and tension free defect closure should be of one consideration.
Perianal Condyloma Acuminata: Factors that Contribute to the Recurrence Jeo, Wifanto S.; Sugiharto, Bobby; Kekalih, Aria
The New Ropanasuri Journal of Surgery Vol. 3, No. 2
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Introduction. Condyloma Acuminata (CA) is the most common sexually transmitted disease caused by HPV with high recurrence rate up to 70%. Factors contribute to the recurrence such as age, site of predilection, previous treatment, HIV infection and sexual behavior were noted in perianal CA. To date the correlation of these factors to the recurrence remains unknown. Method. A cross sectional study was conducted. Patients with history of CA managed in clinic of surgery during period of January 2010 to June 2015 were reviewed. Subject characteristics, i.e. age, infected site, previous treatment, HIV infection and sexual behavior and recurrence were the variables of the study. Data collected from medical record were statistically analyzed. Significant correlation found if p value <0.05. Results. There were 48 subjects with the history of CA. On the analysis, age variable has a significant correlation with the recurrence p = 0.008 (OR = 5.83; 95% CI 1.66–20.56;). The recurrence was higher in productive age compared to non–productive age. Previous anal CA and high risk negative sexual behavior showed a higher recurrence risk than previous non–anal CA and positive sexual behavior (OR = 1.89 and 2.14, respectively). Conclusion. There was significant correlation between age and CA recurrence, anal CA and negative sexual behavior showing 1.89 and 2.14 times, respectively more likely to have recurrence (New Ropanasuri J Surg.2018;3(2):e218).
Risk Factors Associated with Limb Amputation in Necrotizing Fasciitis at dr. Cipto Mangunkusumo General Hospital Jakarta Pratama, Dedy; Harisandi, Sandra
The New Ropanasuri Journal of Surgery Vol. 3, No. 2
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Introduction. Early diagnosis and management of necrotizing fasciitis of the extremities has an impact on mortality and morbidity. Studies have shown a correlation of risk factors (e.g. gender, gangrene, and comorbid) with increased risk of amputations in necrotizing fasciitis. Method. A cross sectional study conducted on subjects diagnosed as necrotizing fasciitis managed at dr.Cipto Mangunkusumo General Hospital during January 2012 to December 2015. The subject characteristics i.e. gender, age, comorbid, wound presentation, pulse, respiratory rate, temperature, serum creatinine level, hemoglobin content, sodium, and leukocytes level were the variables subjected to statistical analysis. Results. There were 70 subjects enrolled; fifty percent were males. and 60% were less than 60 years old. The most comorbid found were hypertension (34.3%), diabetes mellitus (28.6%). and kidney disease (22.9%). Amputation occurred in 24.28% subjects. Female was shown to have a greater risk of amputation than male (p = 0.012). Diabetes mellitus, skin necrosis, gangrene and serum creatinine level ≥1.6 mg/dL were significantly associated as an amputation risk factor (p <0.005). Based on modified LRINEC scoring, 45 subjects were of high risk and 25 were of medium risk. Multivariate analysis showed three strong predictors for amputation were diabetes mellitus (risk ratio 7.685; 95% CI 1.898– 31.122; p = 0.004), gangrene (risk ratio 6.151; 95% CI 1.539–24.584; p = 0.010), and serum creatinine level >1.6 mg/dL (risk ratio 4.098; 95% CI; 0.937–17.255; p = 0.054). Conclusion. Diabetes mellitus, gangrene, and serum creatinine level >1.6 mg/dL referred as risk factors associated with limb amputation in necrotizing fasciitis .
Anastomosis in Intestinal Tuberculosis: A Systematic Review Putranto, Agi S.; Muchtar, Stefanny
The New Ropanasuri Journal of Surgery Vol. 3, No. 2
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Introduction. The heterogeneity of manifestations in intestinal tuberculosis requires different approach. One step or two steps surgical procedure referred to the method of choice to reduce morbidity and mortality. The review aimed to find out the indication to perform primary anastomosis in intestinal tuberculosis. Method. A systematic review was conducted in accordance with PRISMA guideline in June 2018. Literature searches were performed through online databases sites (PubMed, EBSCO, and Ovid) using keywords “intestinal tuberculosis” AND “surgery” AND “anastomosis”. Intestinal pathology, surgical procedures, anastomosis leaks, enterocutaneous fistula, and mortality were the variables of outcome have been analyzed. Results. Twelve articles of cohort studies were critically appraised and analyzed. The selection of the surgical procedure depends on condition, extent disease, nutritional status, and surgeon’s preferences. Resection and primary anastomosis are safe in an obstructive lesion with low incidence of enterocutaneous fistula and anastomosis leaks. The two steps procedure is advisable in intra–abdominal sepsis. Conclusion. In subjects without intra–abdominal sepsis, intestinal resection with primary anastomosis as a definitive procedure might be considered in obstructive lesions and in perforated lesions, with low risk to have anastomosis leaks and enterocutaneous fistulas. In contrast, in septic subjects, two steps procedure is advisable.
Intestinal Duplication Management in Adult Patients: A Systematic Review Putranto, Agi S.; Siregar, Sun P.; Satrio, Taufik B.
The New Ropanasuri Journal of Surgery Vol. 3, No. 2
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Introduction. Gastrointestinal duplication is a rare congenital abnormality found in adults. This intestinal duplication may be associated with complications i.e. perforation, bleeding, obstruction and malignancy. Degeneration to malignancy is a basic consideration to treat a radical surgery, which is preventive. This systematic review aims to provide evidences to evaluate the preventive or conservative surgery in the management. Method. A systematic review conducted according to preferred reporting items for systematic review and meta–analysis protocols (PRISMA). Literature search proceeded on PubMed and ScienceDirect using keywords "malignancy arising from adult duplication gastrointestinal "AND" treatment ". All articles are selected based on inclusion and exclusion criteria. The data evaluated included postoperative complications, recurrence, follow–up and recovery. Results. There were eleven articles – which were case reports – analyzed. These articles reported preventive surgery provide a better outcome than conservative one. Conclusion. Case reports in the study showed that 63% of intestinal duplication were developed to malignancy, requiring preventive surgery (level of evidence IV). However, this should be judge with a careful clinical assessment.
Survival Analysis in Young–Age Breast Cancer and Related Clinicopathologic Factors at dr. Cipto Mangunkusumo General Hospital 2008–2015 Yulian, Erwin D.; Salim, Adrian
The New Ropanasuri Journal of Surgery Vol. 3, No. 2
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Introduction. Various cancer registrations and reports had confirmed the higher proportion of young women with breast cancer in Asian countries. This mandates special attention for clinician since this group of patients need different management approach, especially regarding the more aggressive biological behavior, worse prognosis and the escalating psychosocial burden that young women endure. We conducted a study to describe the clinicopathological characteristics of young–aged breast cancer in Indonesia and its relationship with overall survival. Method. This study is a survival analysis using samples all young–aged women with histologically–proven cancer diagnosis that underwent treatment (surgery and/or chemotherapy and/or irradiation and/or hormonal therapy) since January 2008 to August 2015. Data were collected from both medical records and interview. Data were analyzed using SPSS Results. Young–age women comprise 35% of total breast cancer patients, with most cases were in the locally advanced stage, histologic type NST, grade 2, no lymphovascular invasion, positive hormone receptors, negative HER2 status, high Ki–67 and Luminal B subtype. The 5–year overall survival rates were 64%; variables that showed statistically significant correlation was tumor size, nodal status, metastasis status and clinical stage. Histologic type NST, grade 2, positive lymphovascular invasion, high Ki–67 and positive HER2 were related to survival, but this correlation was not statistically significant. Conclusion. Overall 5–year survival rates of young–aged breast cancer at dr.Cipto Mangunkusumo General Hospital was 64%, much lower that reported figures from literatures and other countries’ reports. Clinical stage was the only variable with statistically significant correlation. Luminal B subtype was observed the most, but the worst survival was found in the HER2 subtype group.
Comparative Analysis of Post Rubber Band Ligation and Stapled Hemorrhoidopexy Complications of Grade 2 and 3 Internal Hemorrhoids Mazni, Yarman; Basir, Ibrahim; Sumanto, Sumanto; Budiningsih, Setyawati
The New Ropanasuri Journal of Surgery Vol. 3, No. 2
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Introduction. The management of second–and third–degree internal hemorrhoid consists of non–surgical and surgical treatments. If non–surgical treatment does not succeed, then the recommended therapy is minimal invasive or surgery, depends on the clinical condition. Along with the development of science and technology, a technique known as rubber band ligation (RBL) and stapled hemorrhoidopexy emerges. In Indonesia, there is no data that can describe the distribution of postoperative complication rate. Method. A comparative cross–sectional study was conducted by gathering short term outcomes data from the subjects' medical records that underwent RBL or SH between 2011 to 2014 in three different hospitals in Jakarta. A univariate analysis was conducted to assess postoperative complications of RBL and SH subjects of second–and third–degree internal hemorrhoids. We use chi square test to assess the factors that influence the complications of categorical variables, and Fisher test if the chi square condition is not met. Results. Among 183 subjects, 49.2% underwent RBL and 50.8% SH. Second degree internal hemorrhoids were 40% and third degree were 60%. Postoperative complications consist of pain (RBL 4.4%, SH 8.8%), hemorrhage (RBL 2.3%, SH 4.9%), urinary retention (RBL 0, SH 2.7%), infection (RBL 0.5%, SH 1.6%) and stenosis (RBL 0, SH 0.5%). Postoperative complications on second degree internal hemorrhoidal was 8.2% and third degree 13.1% (p = 0.71). Complication of subject with third degree internal hemorrhoids after RBL 2.8%, SH 19.4% (p = 0.03). Conclusion. Complications of second– and third–degree internal hemorrhoids post RBL are no different with SH while for third degree internal hemorrhoid, complications after RBL ware significantly lower than SH.
Risk Factors in Descending Necrotizing Mediastinitis Following Submandibular Abscess at dr. Cipto Mangunkusumo Hospital in January 2012 – July 2016 Putra, Muhammad Arza; Pratama, Raditya; Kekalih, Aria
The New Ropanasuri Journal of Surgery Vol. 3, No. 2
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Introduction. Descending necrotizing mediastinitis (DNM) encountered problem of a high mortality rate. The increasing number of incidence and the need of immediate intervention DNM cases urge surgeons to manage early preventions and adequate therapy. The purpose of thisstudy is to find risk factors that correlate to the incidence of DNM in submandibular abscess patients. Method. Cross sectional study conducted enrolling all patients diagnosed with submandibular abscess that developed to DNM and treated surgically in emergency operating theater in period of January 2012 to July 2016 were reviewed. Mediastinitis which was not following submandibular abscess, those were not treated surgically or treated by other than the division of thoracic and cardiovascularsurgery, and those of pediatrics were not included on the study. The incidence of DNM was the dependent variable on the study; risk factors such as gender, age, body mass index (BMI), comorbid(s), leukocyte counts, and microorganism(s) were independent variables on the study. Results. There were 68 subjects enrolled on the study. The met the inclusion and exclusion criteria. Subjects characteristics are shown in table 1. Septic condition, surgical intervention, postoperative complications, and mortality are shown in table 2. There was no correlation between gender (p = 0.656), age (p = 0.763), comorbid(s) (p = 0.767 and 0.952). It also found that leukocyte counts, and cultured microorganism(s) showed no significant correlation. Conclusion. Not a single risk factor specifically correlatesto the incidence of DNM in subjects with submandibular abscess. Thus, so those with submandibular abscess have a same risk to have DNM developed.

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