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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 152 Documents
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Comparative Evaluation of Scar Tissue from Chest Tube Wound Closure Using Knotless and Conventional Methods Using the Patient and Observer Scar Assessment Scale Tangkilisan, Adrian N; Oley, Mendy H; Oley, Maximillian C; Loho, Claudia; Sukanto, Wega; Tamburian, Christha Zenithy; Langi, Fima L.F.G.
The New Ropanasuri Journal of Surgery Vol. 8, No. 2
Publisher : UI Scholars Hub

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Abstract

Introduction. Chest tube placement is widely practiced; most medical doctors can do this safely. However, releasing the chest tube can be a painful and challenging experience for the patient. A novel method has been developed with a new suture material that does not need to be knotted. The Patient and Observer Scar Assessment Scale (POSAS) provides objective and subjective scar assessment. This study aimed to compare the scars associated with chest tube release between the conventional and knotless methods. Methods. The study was a controlled trial in which patients were divided into two groups. The scar assessment was carried out by the researcher and the patient in the third month after the operation, using POSAS scores. Results. The Mann–Whitney test showed significant differences between the methods in both patient and researcher assessments (p Conclusion. According to POSAS scores, scar tissue formation from the knotless method was more acceptable to patients than the conventional method. Therefore, this can be an alternative method for chest tube wound management.
Impact of Advanced Trauma Life Support Training for Improving Mortality Outcome: A Systematic Review and Meta-analysis Putra, Afid B; Nurachman, Luthfian A; Suryawiditya, Bagus A; Risyaldi, Muftah; Sihardo, Lam
The New Ropanasuri Journal of Surgery Vol. 8, No. 2
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Abstract

Introduction. The Global Burden of Disease Study has identified injuries as one of the top ten causes of death and disability worldwide. Injury is predicted to rise in the rankings by the year 2030. This study aimed to quantify the effectiveness of an Advanced Trauma Life Support (ATLS) training in improving mortality outcome after trauma injury. Method. This is a systematic review (of experimental and observational studies) and meta-analysis, reporting mortality outcome from trauma injury between ATLS-trained/certified physicians vs non-ATLS-certified. We performed literature searching through 3 electronic databases, including Cochrane (CENTRAL), MEDLINE (PubMed), and Scopus. Results. There are summarized results from 7 selected articles. The total patients included in this analysis were 11,595 patients in post-ATLS group and 21,603 patients in pre-ATLS group. There was high heterogeneity among studies (I2 = 95%) and therefore random effect model was used for analysis. Pooled analysis showed that ATLS had no significant effect in reducing the risk of mortality (OR: 0.68; 95% CI 0.39 – 1.20; p = 0.18). Although ATLS is not significantly associated with improved mortality outcomes, this meta-analysis has shown a tendency that health facilities and health workers implementing ATLS experienced lower mortality. Conclusion. ATLS is not the only aspect that contributes to patients’ survival. There are also roles in pre-emergency settings, resource availability, and experience. However, we believe that implementing the ATLS protocol in healthcare facilities will be the leading factor in improving trauma patients' management.
Seroma as a Biological Tissue Expander on Post-Mastectomy Reconstruction: A Case Report Kurnia, Ahmad; Muazdhani, Fatahillah
The New Ropanasuri Journal of Surgery Vol. 8, No. 2
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Abstract

Introduction. Previous studies have reported that patient satisfaction with breast cancer management is related to the success of breast reconstruction. The tissue expander used in breast reconstruction today has several disadvantages: the high cost, the nature of the foreign body, and the risk of failure. Seroma has the potential as a natural tissue developer in post-mastectomy reconstruction. This case report aims to describe the technique, results, advantages, and limitations of post-mastectomy breast reconstruction using a seroma as a natural tissue expander that has never been done before. Case Presentation. A 37-year-old woman was diagnosed with stage IIIA non-special type (NST) invasive breast carcinoma stage III without lymphovascular invasion. The patient underwent a modified radical mastectomy (MRM) on the right side breast. Postoperatively, a drain was placed for observation. If no maceration of the skin was found, the drain was removed within the first 24 hours postoperatively to accumulate seroma in the dead space formed in the breast flap. Next, seroma molding is done with a special bra that fits the shape of the bust. Observations were made during the treatment, and the seroma molding process occurred. During the follow-up period, the patient complained of mild pain and did not experience tumor recurrence. Conclusion. This case report shows seroma as a biological tissue expander that can potentially be used as an alternative breast reconstruction method with body fluid accumulation.
Effect of Everolimus on the Liver Function of Children Receiving Liver Transplant with Chronic Rejection: An Evidence–Based Case Report Puruboyo, Adi ND; Rahayatri, Tri H; Stephanie, Marini
The New Ropanasuri Journal of Surgery Vol. 8, No. 2
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Abstract

Introduction. Chronic rejection, a complication after pediatric living donor liver transplantation (LDLT), is challenging to treat as management generally requires retransplantation. However, retransplantation is avoided because of rejection risks, longer operating time, higher mortality, and lower survival rates. Immunosuppressant therapy has potential as an option for nonsurgical treatment. Everolimus, a mammalian target of rapamycin inhibitors (mTOR inhibitors), is a well-known immunosuppressant in treating chronic rejection of LDLT. However, studies in the pediatric field remain minimum. Method. The discussion was based on evidence found from studies found through a systematic literature search. These three studies showed permanent liver function improvement after LDLT on immunosuppressant therapy without Everolimus. Liver function and fibrosis stability improved without mortalities. Differences in Everolimus’ efficacy in improving liver function due to the lack of facility to control Everolimus level in the blood resulted in overwhelming infection due to over-immunosuppression of this drug since Everolimus has a narrow therapeutic range. Conclusion. The administration of Everolimus pediatric after living donor liver transplantation reduces ALT and AST levels and improves fibrosis stability.
Secondary Spontaneous Tension Pneumothorax: A Case Report of an Uncommon Presentation of Post-Tuberculosis Sequelae Willim, Herick Alvenus
The New Ropanasuri Journal of Surgery Vol. 8, No. 2
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Abstract

Introduction. Tuberculosis (TB) remains one of the top life-threatening infectious diseases worldwide. Even after completion of treatment, numerous patients had post-TB sequelae as a consequence of lung damage during TB infection. We reported an uncommon case of secondary spontaneous tension pneumothorax in a patient with post-TB sequelae. Case Presentation. A 68-year-old smoker man presented with sudden shortness of breath since 2 hours ago. He had a history of pulmonary TB 15 years ago which had completed antituberculosis treatment and had been experiencing symptoms associated with post-TB sequelae for the last 1 year. Physical examinations and chest X-ray showed tension pneumothorax. The recent GeneXpert sputum test showed a negative result for Mycobacterium tuberculosis. We performed urgent needle decompression, followed by chest tube insertion. He responded well to the treatment and was discharged after the seventh day with no residual pneumothorax. Conclusion. Spontaneous tension pneumothorax in patients with post-TB sequelae is rare and has a complex pathogenesis. It may include several factors including pulmonary fibrosis, pleural adhesion, ruptured open healed cavity or bullae, and lung damage from cigarette smoking. It should be managed by urgent needle decompression followed by chest tube thoracostomy.
Factors Influencing Ulcer Healing in Chronic Limb Threatening Ischemia Patients after Endovascular Angioplasty at Cipto Mangunkusumo General Hospital Suhartono, Raden; Wijaya, Ghany H; Muradi, Akhmadu
The New Ropanasuri Journal of Surgery Vol. 8, No. 3
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Abstract

Introduction. Chronic limb–threatening ischemia (CLTI) can cause rest pain in the lower extremities and the formation of ulcers or gangrene. Revascularization, which can be done using open surgery or endovascular procedures, is the first line of treatment in CLTI management. CLTI patients at CMGH usually came with advanced conditions and high re–amputation rates even after revascularization. This study aimed to determine factors associated with the outcome of endovascular angioplasty, especially ulcer healing. Method. A cross–sectional study was conducted at CMGH, enrolling CLTI patients with Rutherford grades 5 and 6 who underwent angioplasty. Age, gender, history of smoking, hypertension, atrial fibrillation, heart failure, chronic kidney disease (CKD), and diabetes mellitus were the independent variables of interest in this study. The dependent variable was ulcer healing, a clinical assessment after angioplasty assessed as complete ulcer epithelialization within four months after the procedure. Results. In 133 study subjects, it was found that 60.9% of patients underwent complete epithelialization. Factors that affect ulcer healing in CLTI patients include gender, hypertension, atrial fibrillation, heart failure, chronic kidney disease, and diabetes mellitus. The factor with the strongest association with ulcer healing after endovascular angioplasty based on the logistic regression test is diabetes mellitus. Conclusion. Factors that have a significant association with ulcer healing in patients with CLTI include gender, smoking, hypertension, atrial fibrillation, heart failure, CKD, and diabetes. The factor that was considered to have the strongest association was diabetes mellitus
Preoperative Neutrophil–Lymphocyte Ratio and Serum Carcinoembryonic Antigen as Predictive Factors of Colorectal Cancer Survival Putranto, Agi S.; Kamaruddin, Jackson
The New Ropanasuri Journal of Surgery Vol. 8, No. 3
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Abstract

Introduction. Colorectal cancer is the second leading cause of death worldwide, with a high mortality rate. This study investigates the predictive value of the neutrophil–lymphocyte ratio (NLR) and carcinoembryonic antigen (CEA) in predicting the survival rates of colorectal cancer patients in Indonesia. Method. This retrospective cohort study enrolled the colorectal cancer stage I–IV patients treated at Cipto Mangunkusumo General Hospital (CMGH). The independent variables are NLR and CEA, while the dependent variable is the five–year survival of colorectal cancer. The log rank test proceeded to find a correlation between NLR and CEA with 5–year survival, and the Cox proportional hazard regression proceeded to analyze the predictive value. Results. Of the ninety–six subjects who met the inclusion and exclusion criteria who were enrolled, 6.25% had high NLR, and 66.6% had high CEA levels. The overall five–year survival rate was 35.4%. However, the proportion of subjects with normal NLR had a higher five–year survival rate compared to those with high NLR, and the same pattern was observed for CEA levels. Subgroup analysis based on the cancer stage showed a significant association between high NLR and increased risk of mortality in TNM stages I–II. Still, no significant difference in survival based on NLR was observed in stages III–IV. Conclusion. The preoperative NLR ratio and preoperative CEA did not show a predictive role in colorectal cancer survival. However, when stratifying by cancer stage, there was a significant difference in preoperative NLR levels between the deceased and non–deceased groups in patients with stage I–II colorectal cancer
D-Dimer and Ultrasonography as the Early-Diagnostic Tools for Lower-Limb Trauma Patients with Deep Vein Thrombosis: A Literature Review Muchtar, Faranita; Muradi, Akhmadu
The New Ropanasuri Journal of Surgery Vol. 8, No. 3
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Introduction. The mortality of venous thromboembolism increased among trauma patients. Both the D-dimer test and ultrasonography are selected to diagnose venous thromboembolism due to non-traumatic causes but are rarely utilized in emergency trauma settings. Objectives. This literature review comprehensively explains the accuracy of the D-dimer test and ultrasonography for deep vein thrombosis (DVT) diagnosis. This study finding might broaden the diagnostic recommendation for traumatic patients with deep vein thrombosis. Method. This study used articles from four distinct journal databases. Only eight of the 480 articles found during searching proceeded with the screening process. Thus, five articles were included in the review after matching the eligibility criteria. Results. Three articles compared the accuracy of using the D-dimer test and ultrasonography, while others compared the accuracy of conventional ultrasonography to venography or colour duplex ultrasonography. Using three mg/L as the cut-off point, the D-dimer test's pooled sensitivity and specificity were 88,37% and 96,96%. Meanwhile, ultrasonography for DVT resulted in a pooled sensitivity of 59% and specificity of 95%. Conclusion. Using both tools in trauma cases with DVT would give a more accurate diagnosis. A systematic review of this issue would be preferred to support this argument.
Neutrophil-Lymphocyte-Ratio as Predictor of Morbidity and Mortality in Adults with Gastrointestinal Obstruction Putranto, Agi S.; Pramesta, Bimo D
The New Ropanasuri Journal of Surgery Vol. 8, No. 3
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Introduction. Gastrointestinal (GI) obstruction is a condition that often requires surgery and can lead to severe complications. The neutrophil-to-lymphocyte ratio (NLR) has been used as an inflammation indicator in various medical conditions, but research on the relationship between NLR and GI obstruction is still limited. Therefore, this study aims to evaluate the role of NLR as a cost-effective and simple preoperative predictor of postoperative mortality and morbidity, mainly surgical site infection, in adult patients with GI obstruction. Method. This cross-sectional study was conducted at Cipto Mangunkusumo General Hospital in Jakarta. The study sample consists of 150 adult patients with GI obstruction, with baseline characteristics including gender, age, type of GI obstruction, and neutrophil and lymphocyte levels. Results. Patients who died postoperatively had a higher average NLR (26.50) compared to those who survived (9.77). Multivariate analysis showed that NLR was an independent predictive factor for morbidity (OR = 1.37) and patient mortality (OR = 1.10). This study also identified the optimal preoperative NLR cut-off values as predictors of morbidity (9.95) and mortality (12.51) in postoperative GI obstruction patients, with high sensitivity and specificity. Conclusion. These findings indicate that NLR can be a reliable indicator for predicting surgical outcomes in patients with GI obstruction
Correlation of Thyroid Stimulating Hormone (TSH), T3, and T4 Hormones with Histopathological Characteristics of Thyroid Cancer at Cipto Mangunkusumo General Hospital Kurnia, Ahmad; Bangun, Kristaninta; Muazdhani, Fatahillah
The New Ropanasuri Journal of Surgery Vol. 8, No. 3
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Introduction. In a study spanning 2008 to 2012 at Cipto Mangunkusumo General Hospital (CMGH) Jakarta, 668 cases of thyroid cancer were identified among 18,216 cancer cases. Globally, the papillary subtype is prevalent, and prior research indicates a link between thyroid hormone changes and thyroid carcinoma risk. To improve surgical care, this study aims to find the association between thyroid hormone levels and histological subtypes in thyroid carcinoma patients. Method. This cross-sectional study focused on thyroid cancer patients managed from 2013 to 2017. Despite subjects' characteristics, thyroid hormone levels and histopathological findings were the variables of interest. The findings were analyzed using ANOVA, Kruskal-Wallis, unpaired T-tests, Mann-Whitney tests, and Pearson or Spearman tests to find correlations with age, gender, clinical presentation, and body mass index. Results. The mean age was 48.7 years, with subjects having an average body weight of 64.5 kg, height of 154.4 cm, and BMI of 24.8 kg/m2. Hormonal analysis revealed mean T3 levels at 2.02 ng/mL, T4 levels were slightly lower at 1.92 ng/mL, and TSH levels were the lowest at 1.22 ng/mL. A very weak correlation existed between the T3 hormone and age (r = 0.05, p = 0.77). In the correlation between T4 thyroid hormone levels and age, a weak correlation was found between T4 thyroid hormone levels and age (r = 0.31, p = 0.08). In the correlation between thyroid cancer histopathology and gender, clinical presentation, and BMI, there was no significant association with gender, ?s = 0,01; 95% ??? [-3,37; 3.34]; p=0,94 Conclusion. This study indicates that the TSH, T3, and T4 hormone levels were not associated with the histopathological characteristics of thyroid cancer at CMGH. The T3, T4, and TSH hormone levels were unaffected by gender, nodule involvement, and age

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