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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. 7, no. 1" : 11 Documents clear
Serum CEA Level in Predicting Liver Metastases of Colorectal Cancer Among Young Adult Patients Sihotang, Ely S.P; Putranto, Agi S
The New Ropanasuri Journal of Surgery Vol. 7, No. 1
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Introduction: Incidence and mortality of CRC are currently increasing in those under 50 years. The study aims to determine the predictive value of serum CEA levels as the liver metastases predictor of colorectal cancer (CRC) in young adults. Methods: A cross-sectional study was conducted using secondary data (patient medical records) from 2015–to 2021. Patients aged <50 years who were diagnosed histopathologically with primary colorectal cancer at dr. Cipto Mangunkusumo General Hospital (CMGH) were recruited. We excluded patients with a history of other malignancies, who had undergone operative management for colorectal cancer, and preexisting liver disease. The outcome of this study is the cut-off of the CEA value obtained by the ROC curve and the sensitivity and specificity of the CEA value in predicting CR liver metastases. Results: Out of 181 subjects enrolled, a total of 43.6% were female. Fifty-nine subjects (32.6%) had liver metastases. The CEA level of the metastases group was 208.1 (2.1–12503.2) ng/mL; this was much higher than the non-metastases group, which was 6.27 (0.8– 1099.4) ng/mL (p <0.001). The AUC value was at 0.904, and the CEA level cut-off was 38.765 ng/mL (Youden's Index = 1.718). The sensitivity and specificity were 91.53% (91.5 CI, 81.32%– 97.19%) and 80.3% (72.16%– 86.97%), respectively. The odds ratio of young colorectal cancer patients having liver metastases was 44.10 (95% CI, 15.92–122.20). Conclusion: CEA level ≥38.765 ng/mL has good sensitivity and specificity in predicting liver metastases among young adults with CRC.
Effect of Ischemia-Reperfusion injury and Preconditioning on Lung Parenchyma after Acute Limb Ischemia Hutagaol, David; Susanti, Dhama S; Soeharto, Wuryantoro; Putra, Muhammad A; Wardoyo, Suprayitno; Makdinata, William; Setiawan, Moira
The New Ropanasuri Journal of Surgery Vol. 7, No. 1
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Introduction. Acute limb ischemia, a sudden decrease of perfusion to the extremities, can compromise the survival of the limbs. Medical intervention and surgery are often needed to return perfusion. However, reperfusion injury can trigger oxidative stress and inflammatory response, leading to local and remote tissue damage, such as the lungs, which increases morbidity and mortality. This research aims to study the effects of hypothermia and remote ischemic preconditioning (RIPC) on the lung parenchyma after being exposed to reperfusion after acute limb ischemia in rabbits. Method. Eighteen New Zealand White rabbits were divided into three groups of 6. The femoral artery was ligated to induce ischemia. The hypothermia group was given cooling pads to maintain a temperature of 28°C for 4 hours, and the RIPC group was assigned RIPC before ligation for 5 minutes in three cycles. Both groups underwent reperfusion for eight hours. Evaluation of histologic characteristics was performed independently by a pathologist. Results. The mean scores for the control group, hypothermia group, and RIPC group were 12.03 + 1.43 (severe injury), 8.03 + 3.03 (moderate injury), and 4.80 + 2.61 (mild injury), respectively. In addition, there was a significant difference between lung parenchymal damage in the control group and hypothermia group (p = 0.015) and between the control group and RIPC group (p = 0.000). Conclusion. Both hypothermia and RIPC have a protective effect on lung parenchyma exposed to remote reperfusion injury after lower limb ischemia, where RIPC protects the lungs to a higher degree.
Risk of Upper Extremity Musculoskeletal Injury in Laparoscopy Training Prasetyono, Theddeus OH; Andrian, Christopher R; Kinanthi, Elisabet LA
The New Ropanasuri Journal of Surgery Vol. 7, No. 1
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Introduction. The laparoscopy procedure still has an ergonomic burden that can increase the risk of musculoskeletal injury, especially in the upper extremity. Furthermore, the risk is compounded in laparoscopic training as the trainees have to repeat the same movements many times to achieve competencies. This study revealed the relation between the position and the risk of musculoskeletal injury in laparoscopy training. Methods. A cross-sectional study on nine subjects was conducted during laparoscopy training. By fixing the table height at 77 cm, we measured the operator height and upper extremity positions to relate them to their VAS and DASH scores. Results. The overall ratio of table height to subject height was Conclusions. There is a risk of upper extremity musculoskeletal injury without disabilities. The pain produced by laparoscopy activity has shown to be mild and needs no medication. The wrist position is considered the highest risk of initiating the upper extremity injury.
An Unusual Case of Perforated Appendicitis in Situs Inversus Totalis in Indonesia Martin, Valencia J; Parinding, Imanuel T
The New Ropanasuri Journal of Surgery Vol. 7, No. 1
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Situs inversus is a rare congenital anomaly where the internal organs are transposed in a mirror image. It is commonly unrecognized until a patient comes with a complaint, especially in developing countries where people do not have a routine medical checkup. We report a case of a young female with unusual left lower quadrant pain abdominal pain. Perforated appendicitis leading to peritonitis was confirmed using ultrasonography and successfully treated with laparotomy. Appendicitis should be considered a working diagnosis in lower left quadrant abdominal pain
Graduated Compression Stockings for Deep Vein Thrombosis prevention in Surgical Patients: A Systematic Review Pratama, Dedy; Simatupang, Satria M.H
The New Ropanasuri Journal of Surgery Vol. 7, No. 1
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Introduction. Oral anticoagulant therapy is commonly used to prevent deep vein thrombosis (DVT). However, it might increase the risk of intraoperative and postoperative bleeding. Graduated compression stockings (GCS) reduced DVT risk, but there is a lack of supporting evidence. Thus, the study aimed to find the efficacy of GCS compared to the pharmacological method in high-risk surgical patients. Method. Literature search proceeded in Cochrane, ClinicalKey, and PubMed. Using keywords graduated compression stockings" or "mechanic" or mechanical") and ("pharmacologic" or "oral anticoagulants" or "NOAC") and "comparison" and "prophylaxis" and ("DVT" or "deep vein thrombosis) and ("surgery" or "surgical"). Results. There were six articles reviewed (27,966 participants). The analysis focused on follow-up, diagnostic method, GCS application days, thromboprophylaxis baseline used, and outcomes, i.e., DVT and pulmonary embolism. No statistically significant clinical advantage was found in surgical patients using the mechanical method of GCS for DVT prophylaxis over the pharmacological method. Conclusion. No significant clinical advantage of using the GCS for DVT prophylaxis over the pharmacological method but preventing intraoperative and postoperative bleeding. However, the efficacy of GCS remains an issue to be evaluated, as recently supported by insufficient data. However, GCS implementation as a prophylactic method in surgical patients with a high risk of DVT contraindications for pharmacological prophylaxis is safe.
Revascularization Techniques for Infra-popliteal Peripheral Artery Disease in Diabetic Foot: A Literature Review Suhartono, Raden; Wijaya, Ghany H
The New Ropanasuri Journal of Surgery Vol. 7, No. 1
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Foot ulcers are one of the problems that are often encountered in uncontrolled diabetes mellitus. With diabetic peripheral neuropathy, the typical clinical symptoms of PAD (peripheral arterial disease) may be obscured, leading to critical limb ischemia (CLTI). Diabetes may accelerate atherosclerosis that diminishes blood flow in PAD—further, diabetic patients with PAD often enfaces infra-popliteal lesions and require revascularization. However, studies on revascularization techniques in infra-popliteal PAD remain minimal. We reviewed the literature on EBSCO, and PubMed focused on the revascularization techniques in PAD, namely: expanded polytetrafluoroethylene (ePTFE), saphenous vein graft (SVG), atherectomy, surgical revascularization first, revascularization with endovascular bypass, direct and indirect angiosome revascularization, open surgery, direct bypass, indirect bypass, PTA, drug-eluting stent, pedal artery angioplasty, non-drug balloon angioplasty, DCB balloon angioplasty, infra-popliteal angioplasty, and cryoplasty. The methods of cryoplasty, atherectomy, direct bypass, balloon angioplasty, and eluting drug stent showed a better outcome in infra-popliteal CLTI.
Review: Conventional Thrombectomy with Intraoperative Fluoroscopy in Acute Limb Ischemia Rutherford IIb Angkoso, Heru; Pratama, Dedy
The New Ropanasuri Journal of Surgery Vol. 7, No. 1
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Introduction. Acute limb ischemia (ALI) is a severe condition affecting the extremities and the patient’s survival that requires immediate treatment. It can be treated with either surgical or endovascular revascularization or both (hybrid procedure). It is crucial to evaluate the defect using intraoperative fluoroscopy or angiography in each case. The review aimed to find out the outcomes of the thrombectomy with intraoperative fluoroscopy for ALI Rutherford IIb. Method. According to the PRISMA protocol, the literature search proceeded in online databases, i.e., Cochrane, Scopus, PubMed, and EBSCOhost, with no year limitation on the publication. All articles were screened and critically appraised. Five eligible articles enrolled in this study with 269 patients ALI Rutherford IIb. All selected articles are cohort studies, including prospective and retrospective. Results. The endovascular intervention (with intraoperative fluoroscopy assistance) showed lower mortality and morbidity than open thrombectomy – however, no difference between open and hybrid thrombectomy in mortality rate. In addition, morbidities such as amputation and limb salvage showed no difference significantly between these interventions. Open thrombectomy has a high risk of mortality and amputation. Meanwhile, the endovascular intervention likely showed a risk of reocclusion, thus, requiring a conversion to open thrombectomy. Conclusion. Intraoperative angiography during open thrombectomy may reduce complications of postintervention reocclusion.
Review: Management of Complex Anal Fistula Putranto, Agi S; Layardi, Winda J
The New Ropanasuri Journal of Surgery Vol. 7, No. 1
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Introduction. Complex anal fistula has a high postoperative recurrence rate and incontinence as well. There have been many emerging surgical techniques, but there are no new recommendations for managing complex anal fistula. One of the critical parameters in evaluating surgical technique outcomes is the recurrence rate and incontinence. This study describes postoperative results in recurrence rates and incontinence in various surgical techniques in managing complex anal fistula. Method. This review commenced with literature searches on online databases, including Cochrane Library, MEDLINE (PubMed), ScienceDirect, and CINAHL (EBSCOhost). Results. The study enrolled two RCTs, four systematic reviews, 14 retrospective and prospective studies, and a case series. The recurrence rate and incontinence of fistulotomy, seton drainage, advancement flap, were 4-19% and 0-4%, 3-47% and 0-7%, 20-27%, and 0-38%, respectively. The recurrence rate of LIFT, VAAFT, PERFACT, and TROPIS were 7-16.1%, 7.5-33%, 20-26.7%, and 14%, respectively; no change in pre– and postoperative continence scores. Conclusions. According to this study, the lowest recurrence rate was in the TROPIS procedure and the highest in fistulotomy. Meanwhile, the lowest incidence of incontinence was in LIFT, VAAFT, PERFACT, and TROPIS, and the highest was in the advancement flap procedure.
False-positive Serum IgM/IgG to SARS-CoV-2 in a Rare Pulmonary Neuroendocrine Carcinoma with Ocular Metastasis: A Case Report Pratomo, Irandi P; Priyonugroho, Gatut; Ramdhani, Aris; Zamroni, Dian; Salamah, Thariqah; Susanto, Yayi D.B; Zairinal, Ramdinal A; Witjaksono, Annisa N; Aditianingsih, Dita; Zaini, Jamal
The New Ropanasuri Journal of Surgery Vol. 7, No. 1
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The Coronavirus disease 2019 (COVID-19) pandemic impacts pulmonary cancer management since it shares similar clinical features and creates fear among patients to visit hospitals due to possible in-hospital disease transmission. We report a patient who presented with a rare case of a pulmonary neuroendocrine tumor with an ocular involvement, which, unfortunately, experienced a delay in diagnostics. The first hospitalization was due to superior vena cava syndrome, pleural and pericardial effusions, and swollen left eye. The patient was diagnosed with pulmonary cancer, released after the symptoms were relieved, and expected to visit a referral hospital for further diagnostics and treatments. The patient returned two weeks later with progressing disease, an ocular metastasis, and a reactive serum IgM/IgG to SARS-CoV-2; serial qPCR tests consistently returned negative. The patient was treated with the best supportive care before succumbing to death. Biopsy showed pulmonary tumor cells consistent with a neuroendocrine tumor. Fear of the pandemic makes patients reluctant to seek help from medical facilities. Pulmonary TBC has similar symptoms to pulmonary cancer, which can pose another challenge in diagnosing pulmonary cancer in TB-endemic countries. Thus, patients often present with advanced-stage pulmonary cancer with rare ocular metastasis, as in this report.
Review: Partial Splenic Embolization Outcome on Liver Cirrhosis with Esophageal Varices Suhartono, Raden; Irsal, Muhammad F. A
The New Ropanasuri Journal of Surgery Vol. 7, No. 1
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Introduction. Liver cirrhosis may be followed by complications such as esophageal varices for 30 days mortality rate up to 15-20%. Partial splenic embolism (PSE) or partial splenic embolization has been developed as a safe and effective alternative therapy for managing bleeding in esophageal varices. This study aims to determine the outcome of PSE in patients with liver cirrhosis with esophageal varices. Method. In this review, the literature search proceeded on three online databases (Cochrane Library, MEDLINE (PubMed), and ScienceDirect) according to PRISMA protocol. Through selections, six articles were included, and all were the reports. Results. Of six reports, three were focused on liver function tests, and the other three were focused on bleeding varices. All were comparing before and after embolization. Conclusion. There is a significant difference in serum cholinesterase and a decreasing incidence of varices bleeding before and after PSE treatment. However, there was no significant difference in serum albumin before and after PSE.

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