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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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A Rare Presentation of A Giant Epidermal Cyst of The Parietooccipital Region: A Case Reports Kereh, David; Septiman, Septiman
The New Ropanasuri Journal of Surgery
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Introduction. Epidermal cysts are common benign cutaneous cysts. An epidermal cyst may be classified as a giant epidermal cyst if it exceeds 5 cm. Giant epidermal cysts with a diameter of 5 cm or more are rare but have been reported. The epidermal cyst rarely discloses malignancy. Although rare, a case of malignant change of benign epidermal cyst is possible. We describe here a rare case of a giant epidermal cyst of the parietooccipital region in a 35-year-old man. Case Illustration. A 35-year-old man was admitted to the hospital with a huge swelling over the scalp for the past 30 years. The swelling was non-tender, cystic, measuring 18x13x 9 cm, and was situated in the parietooccipital region. Skull CT revealed an oval shape, hypodense mass, well defined, in the parietooccipital scalp with no intra-cranial extension. Complete excision of the lesion was carried out. Excision of redundant skin is needed to achieve good aesthetic results. Histopathological examination showed a thin layer of benign stratified squamous epithelium and lamellated keratin debris present in the cyst. There is no sign of malignant transformation. Conclusions. It can be stated that although epidermal cyst is a slow-growing benign tumor, it can cause diagnostic difficulties when located in the scalp area and when there is a possibility that cranial bones and even intracranial structures are affected by the cyst. CT, MRI or ultrasonography are crucial to determine if the cyst contacts intracranial structures. The histopathology examination should be done to detect malignant transformation.
Pulmonary Resection in Complicated Primary Pediatric Pulmonary Tuberculosis: An Evidence-based Case Report Wibowo, Hendra; Wardoyo, Suprayitno; Shinta, Dhama
The New Ropanasuri Journal of Surgery
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Introduction. Paediatric pulmonary tuberculosis incidence was increasing, with many undetected cases. Antituberculosis regiments are known to be the treatment of choice for tuberculosis. Even though pulmonary resection for pulmonary tuberculosis has reduced in daily practice, it remains continues to play an important role in several advanced conditions and complications. Currently, there are no specific practical guidelines concerning surgical indications and approaches for pulmonary tuberculosis. We report a case with complicated primary paediatric pulmonary tuberculosis underwent resection and looking for the literature of the best evidence. Method. A case report completed with a discussion based on the best evidence. The database used for the literature search were Cochrane, Medline, ProQuest, and ScienceDirect. Keywords for the search were “primary pulmonary tuberculosis”, “surgery”, “Lung resection”, and “children”. Inclusion criteria were studies in English, children under 18 years old as the subject, and full-text articles available. The assessment carried out according to Oxford Centre for Evidence-Based Medicine 2011. Results. Six cohort studies were analyzed. Surgery indicated for patients with complicated TB that were unresponsive towards treatment. It should be noted that the experiments were done before the standard WHO antituberculosis therapy was applied. Thus, the result may be different from the current application. Conclusion. Currently, there was no guideline on pulmonary resection. However, surgery yielded better mortality and morbidity in children with complicated pulmonary tuberculosis.
Open Surgery with Intraoperative Enteroscopy in Jejunoileal Massive Bleeding in Pediatric Patient: An Evidence-Based Case Report Husni, Rini Y; Rinaldhy, Kshetra
The New Ropanasuri Journal of Surgery
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Introduction. A case report of surgical exploratory laparotomy with intraoperative enteroscopy (IOE) as a treatment in massive jejunoileal bleeding in children. Method. We conducted a literature search on databases such as Cochrane, PubMed, ScienceDirect, and Google Scholar. Abstract and title screening was done based on exclusion criteria, inclusion criteria, and double filtering. The selected article then reviewed using critical appraisal tools based on its validity, importance, and applicability. Selected articles were benchmark to the discussion. Results. The application of open surgery with IOE as the final treatment that can be recommended in the critical or life-threatening condition of jejunoileal bleeding. Conclusion: surgical exploratory laparotomy with intraoperative enteroscopy is the best final treatment that can be a choice for massive jejunoileal bleeding, whether in the acute case or repeated case, supported with the level of evidence 4
Association Between the Adequacy of Preoperative Antituberculosis Treatment with Abdominal Postoperative Morbidity and Mortality on Tuberculosis Patients El Anshori, Riza; Putranto, Agi S.
The New Ropanasuri Journal of Surgery
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Introduction. The adequacy of tuberculosis treatment before abdominal surgery is a dilemma faced by surgeons who aims for low risk of morbidity and mortality. In addition, there is no data on morbidity and mortality post abdominal operation on TB patients in RSCM and RS Persahabatan. Therefore, this research aims to show the correlation between the adequacy of preoperative TB treatment and postoperative morbidity (fistula enterocutaneous, obstruction, and surgical site infection) and mortality. Method. This study is a descriptive-analytic cross-sectional study done in Cipto Mangunkusumo Hospital dan Persahabatan Hospital using total sampling method, a total of 59 subjects with TB and had undergone abdominal operation and was admitted from January 2011 to August 2017, that fulfilled the criteria of this study. Bivariate and multivariate analysis using SPSS was done to analyze the correlation between TB treatment adequacy and postoperative morbidity and mortality. Results 46 subjects (78%) did not receive adequate preoperative TB treatment. The morbidity rate in this study is 29 subjects 49.25% with significant correlation with the adequacy of preoperative TB treatment (p = 0.030). From the three morbidities in this study (fistula enterocutaneous, obstruction, surgical site infection), only surgical site infection (SSI) has significant correlation with TB treatment adequacy (p = 0.048). There is no significant correlation with postoperative mortality (p = 0.564). Compared to elective surgery, emergency surgery has higher morbidity (OR = 1.62; 95% CI 0.58 - 4.53) and SSI (OR = 2.02; 95% CI 0.63 - 6.46) incidence. A significant difference in the incidence of SSI between clean and dirty surgery wound was found (p = 0.030). Multivariate analysis showed that both adequacy of antituberculosis treatment and surgery type are independent risk factors for morbidity (p = 0.025). Conclusion: Adequate preoperative TB treatment lowers the postoperative morbidity such as surgical site infection. There is no significant correlation between adequate preoperative TB treatment and mortality, and other morbidities such as fistula enterocutaneous and obstruction. Morbidity and SSI are more likely to happen in emergency surgery than elective surgery. Both adequacy of antituberculosis treatment and surgery type are independent risk factors for morbidity.
Association between Obesity and Hormone Receptor Characteristics of Primary Breast Cancer at Cipto Mangunkusumo General Hospital, Jakarta, in 2017 Gunardi, Hardian; Kartini, Diani
The New Ropanasuri Journal of Surgery
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Introduction. Obesity is an independent risk factor and prognostic factor of primary breast cancer. Abundant adipose tissue would lead to increment of blood estrogen level; thus, promoting proliferation of cancer cell, especially those with positive estrogen receptor (ER) and progesterone receptor (PR). No study reported the association between obesity and hormone receptor characteristics of primary breast cancer in Indonesia. Method. We collected cases of primary breast cancer which is diagnosed and undergone immunohistochemistry examination at Cipto Mangunkusumo General Hospital in 2017. The subjects divided into obese group and non-obese group. The ER and PR characteristics of both groups were compared Results. We collected 202 cases of primary breast cancer, with 89 cases (44%) in obese group and 113 cases (56%) in non-obese group. The mean body mass index (BMI) of the subjects was 24.45±4.3. Both groups were similar in terms of age, menopausal status, stage, histopathological morphology and grade. No significant association was found between obesity and ER or PR. We analyzed correlation between BMI and the percentage of expressed hormone receptor, but no correlation was found. This finding did not conform with other Western studies. Difference in characteristics of the subjects and other hormonal factors might contribute to the outcome. Conclusion. There is no association between obesity and hormone receptor characteristics of primary breast cancer at Cipto Mangunkusumo General Hospital in 2017. Keywords: obesity, hormone receptor, estrogen, progesterone, primary breast cancer
The Role of Melatonin in Improving Hypoxia in Malignant Tumor: A Mini-Review Kartini, Diani; Taher, Akmal; Panigoro, Sonar S.; Setiabudy, Rianto; Jusman, Sri W; Haryana, Sofia M; Abdullah, Murdani; Rustamadji, Primariadewi
The New Ropanasuri Journal of Surgery
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Initial Experience on Laparoscopic Pyeloplasty in Persahabatan General Hospital, Jakarta: A Case Series Siregar, Moammar AR; Mirza, Hendy
The New Ropanasuri Journal of Surgery
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Introduction. Untreated ureteropelvic junction obstruction would lead to infection and many other complications. The gold standard to treat this condition is pyeloplasty. Nowadays, laparoscopic pyeloplasty has emerged as a potential modality better than open pyeloplasty. Method. Data retrospectively obtained from the medical records of UPJO patients at Persahabatan Hospital, Jakarta. The patient’s age, gender, weight, and BMI noted. Duration of operation, intraoperative blood loss, and complications recorded as the intraoperative status. Length of hospital stay, pain score on the first post-operative day, time to do the daily activity, and return to work recorded as post-operative variables of this study. Results. We included our ten patients who underwent laparoscopic pyeloplasty in our center. The mean of patient’s age is 40.3 ± 17.1 years with 70% male patients. The average body weight and body mass indexes are 62.7 ± 17.8 kg and 24.2 ± 3.9 kg/m2, respectively. Most of the procedures have been done in 225 minutes. Intraoperative blood loss is around 50 mL, with one patient loss his blood around 500 mL. Describing the post-operative outcomes, the average length of stay of the patients is 8.6 ± 1.6 days, with an average visual analog score of 3.5 ± 1.1 on the first post-operative day. The average time needed to recover to daily activity is around 7.3 ± 1.8 days. Conclusion. This study describes our initial experience on laparoscopic pyeloplasty in RSUP Persahabatan Jakarta. The data showed comparable results with other reviews. We need to bring further improvement to our findings along with our experience.
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
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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
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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
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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.

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