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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 12 Documents
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Search results for , issue "vol. 5, no. 1" : 12 Documents clear
Circulating Tumor Cell and Regulator T-Lymphocyte in Core Biopsy for Breast Cancer Panigoro, Sonar Soni; Kartini, Diani; Wulandari, Dewi; Supono, Arif
The New Ropanasuri Journal of Surgery Vol. 5, No. 1
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Abstract

Introduction: Breast cancer is the most common malignancy found in Indonesia. Core biopsy is one of the modalities used in breast cancer diagnosis with sensitivity of 91-99% and specificity of 96-100%. The procedure causes damage to tumor tissue thus causing tumor cells to enter circulation (CTC) and therefore acute inflammation and infiltration of inflammatory cells. In the final phase of infiltration, the number of Tregs cells will increase, as well as secretion of TGFβ and IL-10, creation of immunosuppresion microenvironment, COX2 stimulation by TGFβ then conversion of CD4+ T cells into FoxP3+ (Tregs), therefore the number of Tregs cells will increase. SOX-4 is activated by TGFβ, and then EMT proccess occurs, tumor cells enter circulation and CTC number will increase. Considering the side effect of core biopsy which is entrance of tumor cells to circulation causing the procedure to be in debate/contradicting opinions. Based on this premise, this study aims to investigate whether there is a change and relationship in Tregs count and CTC count before and after core biopsy procedure. Methods: This study includes 32 blood sample from patients with Stage III and IV breast cancer who went to surgical oncology outpatient clinic in Dr. Cipto Mangunkusumo National Central General Hospital (RSCM) and Gatot Subroto Army Hospital (RSPAD) before and 2 weeks after core biopsy during August to December 2016. Blood is sent to Clinical Pathology Laboratory of RSCM-FKUI to be measured its Tregs count (CD4, CD25, FoxP3 biomarker) and CTC count (CK19 biomarker) using flow cytometry. Statistical analysis was performed using Wilcoxon to determine the difference in CTC/Tregs count before and after core biopsy. Spearman correlation test was performed to determine the relationship between Tregs count and CTC count. Results: Results showed decrease in number of CTC after core biopsy with P value of 0.569 (p > 0.05). There was a decline in Tregs count after core biopsy with p value of 0.049. Small rho value (r=0.165, r=0.235, r=0.046) and p value greater than 0.05 signifies that there is no association between Tregs count to CTC count before or after procedure. Conclusion: Core biopsy do not cause increase in CTC or Tregs, however it cannot be concluded that the procedure is safe, despite the significant finding is only in the decline of Tregs count but not for CTC count. There is no association between Tregs count to CTC count before or after core biopsy.
Postoperative Wound Irrigation Using Distilled Water in Preventing Surgical Site Infection in a Tertiary Hospital: A retrospective Cohort and Cost-effective Study Jeo, Wifanto S.; Pratama, Dennis W.; Vanto, Yoni; Kekalih, Aria; Moenadjat, Yefta
The New Ropanasuri Journal of Surgery Vol. 5, No. 1
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Abstract

Background. The incidence of surgical site infections (SSIs) is reducing following the global campaign that requires all the stakeholder involvement. However, of all hospital-acquired infection prevention programs, wound irrigation is hard to be implemented in our hospital. There is a belief that the wound irrigation procedure leading to the spreading of infection. In contrast, the use of antiseptic and topical antibiotic, as well as systemic antibiotic, is uncontrolled high. Thus, we run a cost-effective study of wound irrigation to change the practice. Method. We carried out a prospective cohort study comparing wound irrigation and the standard protocol in wound care in those underwent median laparotomy during the period of January to July 2018. A total of 80 subjects enrolled in this study, which divided into two groups, 40 for each group. The first group was those treated using antiseptics (povidone-iodine) and antibiotic contained paraffin tulle, while the second group was those treated using irrigation. This study performed in the digestive surgery division, which initiated irrigation protocol for wound irrigation. Stitch specimen taken for bacterial culture proceeded on 7th day postoperative and clinical signs of infection following CDC criteria was observed then statistically analyzed. The committee of ethics Faculty of Medicine Universitas Indonesia approved the study. Results. The bacterial culture showed no significant difference (p = 0.82) between the two groups. Clinical signs are showing no significant difference between the two groups (p = 1.00). In the cost perspective, the application of wound irrigation saving IDR 57,500,00 or four USD per subject. Conclusion. Wound irrigation using distilled water efficiently prevent SSIs.
Purse-String Suture for Skin Closure Following Large Thyroidectomy Kurnia, Ahmad; Siregar, Bintang Abadi; Ramli, Muchlis
The New Ropanasuri Journal of Surgery Vol. 5, No. 1
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Introduction. The total number of patients with thyroid nodules, especially large thyroid nodules (> 6 cm diameter), is increasing. However, the conventional suturing technique for closure of thyroidectomies is still only recommended as the standard for the tumor with a diameter up to 6 cm. Hence, this study aims to prove another surgical technique, purse-string stitching technique, for better esthetic outcomes on large thyroidectomy. Methods. This study was a non-randomized control trial. The subjects included the patients of Cipto Mangunkusumo Hospital in 2013 to 2014 with a thyroid tumor > 6 cm in diameter without any history of anterior cervical surgery and positive lymph nodes. Subjects were divided into the purse-string group and the conventional group. Thyroidectomies were done on all subjects, then were closed by the suturing technique of each group. Outcomes were recorded in the follow-up sessions, including wound scar size, wrinkle existence, and subject’s satisfaction level. Results. Purse-string technique resulted in shorter scar length compared to the conventional technique (median 35 mm vs. 94 mm, p< 0.01). The other outcomes, such as the width of the scar (median 3 mm vs. 2 mm, p=0.265), the presence of wrinkles (0 vs. 2, p=0.480), and satisfaction level of subjects (median 9 vs. 9, p=0.287) were also assessed. Conclusion. The purse-string suturing technique on large thyroidectomy wound closure could be an alternative, besides the conventional suturing technique for a better esthetic result.
Intraoperative Pancreatic Assessment in Pancreaticoduodenectomy The Correlation with Pancreatic Fistula Formation Mazni, Yarman; Syafiuddin, Ardani F; Putranto, Agi S
The New Ropanasuri Journal of Surgery Vol. 5, No. 1
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Abstract

Background Pancreatic cancer affects 25,000 to 30,000 people in the United States each year and is the fourth or fifth leading cause of cancer-related death in this country. It is generally resected by pancreaticoduodenectomy, with or without preservation of the pylorus and proximal duodenum. Anastomotic leaks, intra-abdominal abscesses, and delayed gastric emptying account for most of the perioperative complications after pancreaticoduodenectomy. Anastomotic leaks of pancreas are resulted pancreatic fistula about 45%. A lot of study that have been done to find risk factors of postoperative pancreatic fistula (POPF) with contradictive results. Method This study was done for 70 patients of pancreaticoduodenectomy procedure. Data was collected from medical record in 2016-2019. The data are pancreatic texture, pancreatic duct diameter, pancreaticojejunal anastomotic technique, use of stent in pancreaticojejunal, and POPF. We analyzed the data bivariat with Spearman. Results There are 41,4% male and 58,6% female, Patient with underweight about 21,4%, normoweight 57,1%, overweight 15,7%, dan obese 5,7%. Patient with Diabetes Melitus (DM) about 11,4% and no DM 88,6%. The mean of blood glucose is 136,03 mg/dl. Patient with no POPF about 21,4% and with POPF 78,6%. The A type POPF about 69,1%, B type 14,5%, and C type 16,4%. Pancreatic duct diameter 78,6% and >3 mm about 21,4%. Soft texture pancreas about 22,9% and hard 77,1%. Use of stent about 21,4% and no stent 78,6%. Pancreaticojejunal anastomotic type of dunking or invaginating about 82,9% and duck to mucosa sebanyak 17,1%. The significant risk factor in univariate analysis is diameter of the pancreatic duct (p=0,007). Conclusion Diameter of the pancreatic duct can be used as a risk factor to predict POPF in pancreaticoduodenectomy procedure.
Evaluation of the Implementation of ERAS Protocol in Colorectal Surgery at dr. Cipto Mangunkusumo General Hospital, Jakarta Jeo, Wifanto S; Mazni, Yarman; Suryadi, Andre S
The New Ropanasuri Journal of Surgery Vol. 5, No. 1
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Abstract

Background: The enhanced recovery after surgery (ERAS) protocol, an evidence-based perioperative strategy, has been proven in reduces the postoperative length of stay and perioperative complications rates in colorectal surgery. The implementation of ERAS defined by 15 components. However, the evaluation of ERAS component that have been applied to the outcomes in unclear. Methods: A retrospective study was performed on 63 patients who undergone elective colorectal surgery based on ERAS protocol from January 2015 to December 2017 at Cipto Mangunkusumo Hospital. Patient characteristics, demographic, clinical findings, and length of stay (LOS) colleted from medical records. The relationship between the number of ERAS that accomplish and LOS was analyzed. Result:All patients implemented up to 11 of 15 ERAS components. The mean age of the patients was 53 years old; 46% of patients were males, and 54% were females. There were no mortality rates. The morbidity rate was 7.9%, caused by surgical site infection 1.6%, pneumonia 1.6%, and urinary retention 4,8%. The most common location for colorectal tumour and procedure were sigmoid (47,6%) and colostomy closure (25,4%). There was a relationship between the total ERAS component protocols and the average length of stay (p Conclusion: The higher number of ERAS components applied to one patient, the shorter LOS for postoperative care needed.
Risk Factors that Influence Hospital Length of Stay in Diabetic Foot Ulcer with Negative Pressure Wound Therapy at RS. dr. Cipto Mangunkusumo Simbolon, Prabowo W; Ibrahim, Hilman
The New Ropanasuri Journal of Surgery Vol. 5, No. 1
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Introduction. It is estimated that around 15% of diabetic patients will experience diabetic foot ulcer (DFU) in their lifetime. Negative Pressure Wound Therapy (NPWT) is proven to be more effective than conventional treatments. NPWT creates a moist wound environment, increases local blood flow and stimulates tissue granulation thereby accelerating wound healing. This study was conducted to determine the risk factors that affect the length of stay of DFU with NPWT. Knowing this risk factors may be helpful for optimizing management strategy. Method. This research was a retrospective study with a cross-sectional analytic design in 105 subjects treated in January 2016 to December 2018 at RS. dr. Cipto Mangunkusumo. Patient characteristics, demographics and risk factors were taken from medical records. The length of stay of the patient from the first application of NPWT to its outcomes was the main result, then the correlation to the risk factors that influence it was analyzed. Results. The length of stay of DFU with NPWT was 19.9 ± 19.3 days. Risk factors affecting the length of stay were history of ulcers (r = 0.01; p = 0.034), wound depth (r = 0.292; p = 0.003), Hb (r = 0.05; p = 0.039), HbA1c (r = 0.06; p = 0.033), Albumin (r = 0.06; p = 0.017), PCT (r = 0.10; p = 0.035), and duration of DM (r = 0.193; p = 0.009). Conclusion. This study showed that the length of stay of DFU with NPWT was influenced by systemic factors (duration of DM, Hb, HbA1c, albumin, and PCT) and local factors (history of previous ulcers and wound depth). The depth of the wound was the most positively related factor to the length of stay in DFU post NPWT (r = 0.292; p = 0.003). Interventions on factors that can be corrected before the application of NPWT may amplify the result of NPWT and reduce the length of treatment.
A Solitary Bone Plasmacytoma In the Mandible: A Case Report Yulian, Erwin D; Suryadi, Andre S
The New Ropanasuri Journal of Surgery Vol. 5, No. 1
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Abstract Introduction: Solitary bone plasmacytoma (SBP) is a localized neoplasms in the bone consisting of abnormal plasma cells. We herein report an unusual case of SBP that presents in mandible bone. Case Illustration: A 57-year-old woman, with chief complaint for the lump at right jaw, which gradually increasing in size since 13 years ago. Diagnosis was based on clinical, radiological, and histopathological findings. The patient was referred for radiotherapy before surgery using 50 Gy dose of radiation for 25 times with the result of partial response, followed by hemimandibulectomy and reconstruction with free fibular flap. Complete resection in a form of hemimandibulectomy can eliminate monoclonal proteins in serum, and can reduce the progression of the disease into multiple myeloma. Patient was still in regular visits to oncology surgery clinic in RSCM, with no reccurence of disease after six months of postoperative.
Capsular Contracture, Prolonged Use of Breast Implants with Pleural Effusion: a Case Report Moenadjat, Yefta
The New Ropanasuri Journal of Surgery Vol. 5, No. 1
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A case with prolonged implanted breast prosthesis experienced a prolonged capsular contracture complicated with pleural effusion. A complete capsular removal proceeded instead of removal of the prosthesis solely. The present case aimed to share experiences that may add to the scientific horizon regarding the rare complications of breast prosthesis and rarely reported.
Hernia Through Winslow Foramen in Cipto Mangunkusumo General Hospital, Jakarta: A Case Report Ristiyanto, Eko; Wibowo, Taufik A; Syaiful, Ridho A; Philippi, Benny; Lalisang, Toar J.M.
The New Ropanasuri Journal of Surgery Vol. 5, No. 1
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Introduction. Hernias through Winslow foramen are extremely rare, occurred for 0.1% of all abdominal hernias and found during laparotomy due to strangulated bowel obstruction. This study aims to describe hernia of Winslow foramen and its management. Method. Data were retrospectively collected based on medical records. Clinical manifestations, laboratory data, supporting radiographic examinations, treatment, postoperative care, and outcomes were collected. Case summary. We report the first case of Winslow foramen hernia at Cipto Mangunkusumo General Hospital, Jakarta. A man 54 years in 2019. Ileus was the main clinical symptoms and presented epigastric pain, nausea and vomiting. Plain abdominal x-ray confirmed small bowel obstruction but the etiology was unclear. Emergency laparotomy was performed and a herniated loop of ileum was found entering the lesser sac through the Winslow foramen. The loop of ileum was reduced and viable, omental patch was put on Winslow foramen as plasty procedure. Conclusion. Symptoms, clinical examination is non-specific and laboratory findings are rarely helpful. Retrograde analysis on the plain abdominal x-ray should be considered as abdominal internal hernia through Winslow foramen. The surgical management of hernia through Winslow foramen based on surgeon preference and the viability of the herniated intra-abdominal contents.
Endovascular Management of Post Traumatic Lower Extremity Pseudoaneurysm: An Evidence Based Case Report Darwis, Patrianef; Subrata, Feyona H
The New Ropanasuri Journal of Surgery Vol. 5, No. 1
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Introduction. Increasing incidence of trauma all over the world will increase the risk of vascular trauma, so will the prevalence of pseudoaneurysm. Post traumatic pseudoaneurysm occurs within days or months and commonly diagnosed as hematoma in its early presentation. An effective, less invasive, and low-cost treatment with high rate of survival is needed by patients with post traumatic pseudoaneurysm. Endovascular surgery is one of the less invasive techniques. This case report was made to find out the effectivity of endovascular surgery in the treatment of post traumatic pseudoaneurysm. Method. Literature searching was performed in Cochrane Library, EBSCOhost, ClinicalKey, Pubmed, dan Proquest database. Five articles were found to be relevant to the topic. There were only case report articles with level of evidence level 4 based on Oxford Centre for Evidence Based Medicine 2011. Results. Endovascular surgery approach was effective in the treatment of post traumatic lower extremity pseudoaneurysm for those who were not eligible for open surgery or conservative technique. Patients were given long term dual antiplatelet therapy for 6-12 months. Within 6-18 months of follow up, the pseudoaneurysm was completely obliterated and the patients were symptoms free. Conclusion. Based on level of evidence number 4 endovascular surgery approach can be used for post traumatic pseudoaneurysm patients who were not eligible for open surgery or conservative technique. Further research is needed to know the side effect and complication of endovascular surgery

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