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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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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
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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
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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
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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
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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
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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
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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.
How early is early…? The Role of Abdominal Reoperation Predictive Index at dr. Cipto Mangunkusumo General Hospital, Jakarta Marbun, Vania MG; Lalisang, Toar JM
The New Ropanasuri Journal of Surgery
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Introduction. Determining the right timing of relaparotomy has always been a challenge and hence a simple objective value is required. Abdominal reoperative predictive index (ARPI) proposed to decide when to reoperate. The study aimed to ascertain whether ARPI could be applied in decision making for relaparotomy at dr.Cipto Mangunkusumo General Hospital (RSCM), Jakarta. Method. A cross sectional study carried out on those underwent relaparotomy in Department of Surgery at RSCM during period of 2009–2015. The follow–up carried out by the residents under supervision of attending surgeons, the laboratory findings were reviewed and tabulated in accordance with clinical variables of ARPI. Eight variables of ARPI were reviewed in these subjects. Results. There were 30 subjects reviewed. In this study there were four frequent variables, i.e. persistent symptoms (for more than 4 days after relaparotomy), abdominal pain (that remains for 48 hours after relaparotomy), surgical site infection (90%), and ileus (70%). Seventy–three–point three percent carried out in more than 7 days after primary operation, while as only 10 percent underwent relaparotomy less than 4 days after primary operation. Conclusion. ARPI is practical guide and may be implemented in helping surgeons to decide relaparotomy should there required. Low compliance lead to delay in the management and associated with high mortality.
Risk Factors of Colorectal Carcinoma Incidence in Young Adults: A Meta-Analysis Putranto, Agi Satria; Julistian, Julistian
The New Ropanasuri Journal of Surgery
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Introduction. The incidence and mortality of colorectal cancer (CRC) in young adults (below the age of 50 years) has been increased. However, there’s no screening method for these cancer in those group of age because there isno scientifically proven risk factor. Thus, a meta-analysis carried out to find out the risk factor for CRC in young adults. Method. A Meta-analysis study was conducted in January 2017. Literature search addressed to the articles published during a period of 2007– 2017 in Cochrane and PubMed using keywords: “young” AND “risk factor” AND “colorectal cancer” OR “colon cancer” or “rectal cancer”. Inclusion criteria were the CRC prevalence, risk factor analysis for CRC incidence and young population (below 50 years old). The meta-analysis carried out through qualitative and quantitative approach. Results. In the last 10 years, there were twelve published articles met the criteria. Those were cohort study (an article), case–control study (four articles), and cross–sectional study (seven articles). Twenty–five risk factors were noted. The meta–analysis showed that gender (males) with OR = 1.66, 95% CI = (1.04–2.64); I2 = 93%), family history with OR = 2.01, 95% CI = (1.11–3.67); I2 = 78%), metabolic syndrome with OR = 1.80, 95% CI = (1.49–2.16), I2 = 0%), and smoking with OR = 1.57, 95% CI = (1.40–1.77), I2 = 4%) were the significant risk factors with the association of CRC. Conclusion. Young adults of males, with a family history of CRC, metabolic syndrome, and smoking were at the risk to have colorectal cancer
Long–Term Patency Post–Endovascular Salvage Procedure and the Influencing Factors Darwis, Patrianef; Sitorus, Londung B.; Muradi, Akhmadu
The New Ropanasuri Journal of Surgery
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Introduction. The limited durability of vascular access referred to the great challenges in hemodialysis. An immature arteriovenous fistula (AVF) that inadequately develops to support dialysis noted as the leading cause to immature AVF if stenosis found after creation. The endovascular fistula salvage (EFS) addressed for the preemptive repair of immature AVF despite surgicalrevision. However, no study on EFS proceeded in Indonesia with its specific characteristics. Thus, this study aimed to evaluate the efficacy of EFS and its influencing factors. Method. A retrospective cohort study carried out on those with immature AFV who underwent EFS procedures during the period ofJanuary 2016 to December 2016. The primary patency after EFSwas assessed in correlation to subjects’ characteristics, anatomical variations, diabetes mellitus, and the length and diameter of balloon to post EFS patency Results. There was 125 stenosis noted, a total of 66 stenoses noted in juxta anastomosis. The average length of stenosis was 33.18 mm. Age, diabetes mellitus, length of stenosis and multiple stenoses were found as the influencing factors to the primary patency. The length of stenosis was the most influencing variable in 6 months primary patency (p
Intraoperative Blood flow Rate as a Predictor for Maturity of Radiocephalic Arteriovenous Fistula Pratama, Dedy; Darwis, Patrianef; Yang, Andrew Jackson
The New Ropanasuri Journal of Surgery
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Introduction. Arteriovenous fistula (AVF) is the best access for hemodialysis. The failure of arteriovenous fistula maturation is currently a major problem faced today. This study aims to assess whether an intraoperative blood flow rate measured with Doppler ultrasound can be a predictor of the maturity ofradiocephalic AVF. Method. Subjects were patients to be made radiocephalic AVFwith USG mapping according to the standard. Shortly after, the anastomosis blood flow rate was measured with a linear probe Doppler ultrasound. This study used a cross-sectional analytic design to obtain radiocephalic AVF maturation relationship with intraoperative blood flow rate. Results. Radiocephalic AVF (n = 71) in 71 patients were made and evaluated in 6 weeks. The mean intraoperative blood flow rate in mature fistulas was significantly higher than those which did not mature (201.85 and 141.96 mL/min; p 165.5 mL/min has a good predictor value for radiocephalic AVF maturation. Thus, it can be used as a reference to determine whether the surgeon needs for further assessment and revision intraoperatively, which in turn is expected to decrease the maturation failure rate of arteriovenous fistula.

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