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Sriwijaya Journal of Surgery
Published by Universitas Sriwijaya
ISSN : -     EISSN : 27223558     DOI : https://doi.org/10.37275/sjs.v2i2
Core Subject : Health,
Medicine & Pharmacology
SRIWIJAYA JOURNAL OF SURGERY Sriwijaya Journal of Surgery (SJS) is a peer-reviewed journal published twice a year (June and December) by Department of Surgery, Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia. SJS is intended to be the journal for publishing articles reporting the results of research on surgery. SJS invites manuscripts in the various topics include: General Surgery, Gastrointestinal Surgery, Neurosurgery, Orthopedics, Oncology Surgery, Thoracovascular Surgery, Reconstruction Surgery, Children Surgery, Urology, all aspect related surgery and medicine.
Arjuna Subject : Kedokteran - Pembedahan
Articles 141 Documents
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Mortality Predictors in Spontaneous Intracerebral Hemorrhage: External Validation of the ICH Score in the Indonesian Surgical Population Grady Christian; Trijoso Permono; Ziske Maritska
Sriwijaya Journal of Surgery Vol. 9 No. 1 (2026): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v9i1.143

Abstract

Introduction: Spontaneous intracerebral hemorrhage (ICH) is a major contributor to stroke-related mortality and long-term disability, particularly in Indonesia, which faces the highest age-standardized stroke mortality rate in Southeast Asia. This study evaluates the predictive accuracy of the ICH Score for 30-day mortality among patients undergoing surgical intervention at a primary referral center in South Sumatra. Methods: This analytical observational study utilized a retrospective cohort design, analyzing 81 patients with spontaneous ICH who underwent surgical evacuation at Dr. Mohammad Hoesin Central General Hospital Palembang between July 2024 and June 2025. Demographic, clinical, and radiological parameters were evaluated. Accuracy was determined using Receiver Operating Characteristic (ROC) curve analysis to establish the Area Under the Curve (AUC), sensitivity, and specificity. Results: The cohort was predominantly male (56.8 percent) and aged under 80 years (86.4 percent). Significant predictors of 30-day mortality included age 80 years or older (p < 0.001, OR 26.84), lower Glasgow Coma Scale (GCS) scores (p = 0.012), and the presence of intraventricular hemorrhage (IVH) (p < 0.001, OR 15.24). ROC analysis demonstrated an AUC of 0.958 (95 percent CI 0.910–1.000). An optimal ICH Score cut-off of 3 or higher yielded a sensitivity of 86.2 percent and a specificity of 100 percent. Conclusion: The ICH Score serves as an exceptionally accurate prognostic tool in the Indonesian surgical population. An admission score of 3 or higher is a definitive predictor of mortality, facilitating risk stratification and informed clinical decision-making.
Inverse Association between Occupational Ultraviolet Radiation and Renal Cell Carcinoma Incidence: A Systematic Review and Meta-Analysis Rezza Dwi Haryanto
Sriwijaya Journal of Surgery Vol. 9 No. 1 (2026): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v9i1.144

Abstract

Introduction: Renal cell carcinoma (RCC) incidence is rising globally. While lifestyle risk factors like obesity and smoking are established, environmental modifiers remain contested. Ultraviolet (UV) radiation induces endogenous vitamin D synthesis, which exhibits potent antineoplastic properties in renal tissues. This systematic review and meta-analysis investigated the association between occupational UV radiation exposure and RCC incidence, addressing confounding variables and geographic variations. Methods: Following PRISMA guidelines, a comprehensive search of PubMed, EMBASE, Cochrane Library, and Web of Science was conducted for observational studies published up to August 2024. Data extraction focused on occupational UV exposure and RCC incidence. Methodological quality was assessed using the Newcastle-Ottawa Scale. Meta-analysis utilized RevMan software to calculate pooled odds ratios (OR) and Standardized Mean Differences (SMD) with 95% confidence intervals (CI). Publication bias was evaluated via funnel plots and Egger’s test. Results: Ten high-quality studies encompassing 364,959 participants were included. The pooled meta-analysis demonstrated a statistically significant inverse association between occupational UV radiation and RCC incidence (OR 0.89; 95% CI 0.87–0.91; p < 0.00001) using a fixed-effects model. SMD analysis of cumulative exposure supported these findings. Subgroup analyses by gender indicated protective trends for both males (OR 0.80) and females (OR 0.75). Funnel plot symmetry indicated no significant publication bias. Conclusion: Long-term occupational UV radiation exposure is significantly associated with a reduced risk of RCC. This protective effect is likely mediated by sustained vitamin D synthesis modulating the renal tumor microenvironment. Future research must utilize personal dosimeters and account for latitudinal gradients to refine occupational health guidelines.
Prognostic Factors for Pain Reduction After Balloon Kyphoplasty in Osteoporotic Vertebral Compression Fractures: A Case Series Rachmad Susilo; Rendra Leonas; Debby Handayati Harahap
Sriwijaya Journal of Surgery Vol. 9 No. 1 (2026): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v9i1.145

Abstract

Introduction: Osteoporotic vertebral compression fractures (OVCFs) are a leading cause of morbidity and disability worldwide. While balloon kyphoplasty provides significant pain relief, prognostic factors for optimal pain reduction outcomes remain debated, particularly in Southeast Asian populations with distinct epidemiological characteristics. Methods: A retrospective case series analysis of 30 patients with OVCFs who underwent balloon kyphoplasty at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia, between January 2024 and December 2025. Pain was assessed using the Numerical Pain Rating Scale (NPRS) before surgery and at discharge. Seven potential prognostic variables were examined: age, gender, bone mineral density (BMD), kyphotic angle, duration of complaints, number of vertebral levels treated, and preoperative pain severity. Bivariate analysis using Pearson and Spearman correlation coefficients was performed, followed by multivariate linear regression analysis with entry criteria of p < 0.25. Results: Mean age was 67.2 ± 7.39 years (range 54-82 years), with 80% female patients (n = 24). Pain scores decreased significantly from a preoperative mean of 7.43 ± 0.77 to a postoperative mean of 2.8 ± 0.81 (p < 0.001), representing a 62.3% reduction. Bivariate analysis revealed significant associations for six variables. Multivariate regression analysis identified two independent prognostic factors: duration of complaints (β = -1.881, p < 0.001) and age (β = -0.428, p = 0.039), with an adjusted R² of 0.702. Patients with shorter symptom duration and younger age experienced greater pain reduction. Asymptomatic cement leakage occurred in two patients (6.7%), with no serious complications observed. Conclusion: Balloon kyphoplasty effectively reduces pain in osteoporotic vertebral compression fractures. Duration of complaints and patient age are independent prognostic factors for pain reduction outcomes. These findings may guide patient selection and expectation management in clinical practice.
Baumann's Angle and Shaft-Condylar Angle as Predictors of Functional Outcome After Surgery for Neglected Supracondylar Humerus Fractures in Children Bunyamin; Nur Rachmat Lubis; Mochammad Ridho Nur Hidayah; Irfannuddin
Sriwijaya Journal of Surgery Vol. 9 No. 1 (2026): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v9i1.146

Abstract

Introduction: Neglected supracondylar humerus fractures in children remain a significant source of functional impairment, particularly in developing countries. Radiographic parameters such as Baumann's angle and shaft-condylar angle have been proposed as indicators of fracture alignment, yet their association with functional outcomes after surgical intervention has not been systematically evaluated in neglected cases within Southeast Asian populations. Methods: This cross-sectional observational analytic study examined medical records of 28 children treated surgically for neglected supracondylar humerus fractures at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia. Radiographic measurements of Baumann's angle and shaft-condylar angle were obtained preoperatively and at three months postoperatively. Functional outcomes were assessed using the Flynn criteria. Receiver operating characteristic curve analysis with the Youden index determined optimal cut-off values. Results: Mean age was 9.04 ± 3.0 years, with male predominance (75%) and left-sided involvement (71.4%). Mean surgical delay was 188.4 ± 166.3 days. Postoperatively, 100% achieved satisfactory cosmetic outcomes, while functional satisfaction occurred in 64.3% of patients. Normal Baumann's angle was associated with satisfactory functional outcomes (odds ratio 18.667, 95% confidence interval 2.533–137.587, p=0.003). The shaft-condylar angle with population-specific cut-off of 41.80° demonstrated a significant association (odds ratio 11.333, 95% confidence interval 1.048–122.549, p=0.041). Absolute risk difference for Baumann's angle was 62.0%, and for the shaft-condylar angle, the cut-off was 53.9%. Conclusion: Normal Baumann's angle was strongly associated with satisfactory functional outcomes following surgical management of neglected supracondylar humerus fractures. A population-specific shaft-condylar angle cut-off of 41.80° showed a significant association with functional outcomes. Both parameters warrant consideration during operative planning, with multivariate confirmation recommended in larger prospective studies.
Neglected Transverse Patella Fracture in a Geriatric Patient Following Traditional Bone-Setting: Successful Surgical Salvage with Combined Tension Band Wire and Circumferential Cerclage Construct Restu Adi Wardana; Ramco Abtiza
Sriwijaya Journal of Surgery Vol. 9 No. 1 (2026): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v9i1.147

Abstract

Introduction: Patellar fractures constitute about 1% of all skeletal injuries and disproportionately affect elderly women because of osteoporosis and low-energy falls. Displaced transverse fractures disrupt the knee extensor mechanism and, if unaddressed, predispose to non-union and permanent disability. In many low- and middle-income settings, initial referral to traditional bone-setters remains common and frequently delays definitive care. Case presentation: A 66-year-old woman presented one month after a simple fall with a displaced transverse fracture of the left patella and Kellgren–Lawrence grade II osteoarthritis of the same knee. Prior care was limited to traditional bone-setting without improvement. On admission, she had a palpable patellar gap and an inability to actively extend the knee. Radiographs confirmed displacement of 10 mm. Single-stage open reduction and internal fixation with a modified tension band wire construct reinforced by circumferential cerclage was performed. Active-assisted flexion began on postoperative day 14; by four weeks, she had 30° of pain-free flexion, full active extension, and primary wound healing, and was discharged for structured outpatient physiotherapy. Conclusion: A combined tension band wire plus circumferential cerclage construct provided reliable fixation and an encouraging early functional result despite a one-month delay and prior bone-setter manipulation. Prompt referral and structured rehabilitation remain pivotal for minimising non-union, hardware failure, and long-term disability in geriatric patellar fractures.
Diagnostic Accuracy of the Modified ABSI Versus the Revised Baux Score for In-Hospital Mortality Prediction in Adult Burn Patients at a Tertiary Indonesian Burn Centre Ilham Taufan Ikramiawan; Abda Arif; Theodorus
Sriwijaya Journal of Surgery Vol. 9 No. 1 (2026): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v9i1.148

Abstract

Introduction: Rapid bedside risk stratification of burn-injured patients informs intensive-care admission, fluid-resuscitation intensity, and timing of early surgical excision and grafting. The Modified Abbreviated Burn Severity Index (mABSI) and the Revised Baux (R-Baux) score are widely cited but have not previously been compared head-to-head in a Sumatran tertiary burn unit. Methods: STARD-aligned retrospective diagnostic-accuracy study of consecutive thermal-burn patients admitted to the Burn Unit, Dr. Mohammad Hoesin General Hospital Palembang (January–December 2025). Patients with concurrent major trauma or incomplete records were excluded. Both scores were calculated from medical records by an investigator blinded to the outcome. In-hospital mortality was the reference standard. Receiver-operating-characteristic, Wilson-CI sensitivity/specificity, DeLong AUC comparison, McNemar paired test, and Cohen's κ analyses were performed in SPSS v25 (α = 0.05). Results: Of 45 included patients (mean age 40.8 years; 77.8% male; 64.4% fire burns), 20 (44.4%) died. Optimal cutoffs were mABSI ≥ 5 (AUC 0.811, 95% CI 0.688–0.934; sensitivity 72.0%, specificity 75.0%, Youden 0.47) and R-Baux > 60 (AUC 0.808, 95% CI 0.678–0.938; sensitivity 52.0%, specificity 82.0%, Youden 0.34). Inter-test agreement was substantial (κ = 0.69, 95% CI 0.48–0.90; p < 0.001), with overall accuracy of 84.4% when R-Baux was treated as the comparator. Conclusion: Both scores discriminated burn mortality well; the Modified ABSI offered higher sensitivity and Youden index, supporting its evaluation as a primary triage tool in similar Indonesian tertiary burn units, while the Revised Baux retained complementary specificity for confirmatory risk classification.
Synchronous Low-Grade Appendiceal Mucinous Neoplasm, Perforated Ascending Colon Diverticulitis, and Mature Ovarian Cystic Teratoma in a 52-Year-Old Female: Diagnostic Challenges and Surgical Decision-Making I Made Aridana Sandika; Maria Yustina
Sriwijaya Journal of Surgery Vol. 9 No. 1 (2026): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v9i1.149

Abstract

Introduction. Low-grade appendiceal mucinous neoplasm (LAMN) is a rare mucin-producing epithelial tumor identified in roughly 0.13–1% of appendectomies, with a recognized risk of pseudomyxoma peritonei (PMP) on rupture. Synchronous coexistence with perforated ascending colon diverticulitis and an ipsilateral ovarian mature cystic teratoma is exceptional and creates a triple-layered diagnostic and operative challenge. Case Presentation. A 52-year-old Indonesian female presented with one month of right lower quadrant (RLQ) pain that worsened over forty-eight hours, accompanied by nausea and vomiting. Examination revealed McBurney tenderness, local muscular defense, and a palpable RLQ mass. Leukocytosis with neutrophilic predominance (white blood cells 19.18×10³/µL; neutrophils 91%) was noted. Ultrasonography demonstrated a lobulated, hyperechoic pelvic mass measuring 10.46 cm. Contrast-enhanced computed tomography showed a solid–cystic pelvic lesion with fat and calcification consistent with mature cystic teratoma alongside a periappendicular infiltrate. Exploratory laparotomy disclosed ~50 mL of purulent fluid, an abnormally enlarged appendix, multifocal ascending colon diverticulitis with perforation, dense adhesions, and a right ovarian mass. Right hemicolectomy with transverse colon stump and end ileostomy together with total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO) were performed. Histopathology confirmed LAMN with periappendicular infiltrate and a mature cystic teratoma of the right ovary. Conclusion. Coexistence of LAMN, perforated colonic diverticulitis, and mature ovarian teratoma can mimic adnexal or inflammatory disease and obscure recognition of the appendiceal neoplasm. Vigilant intra-operative inspection of the appendix and adjacent colon, oncologically appropriate resection, and definitive histopathology are essential to prevent PMP.
Marshall CT Classification as an Early Radiological Predictor of In-Hospital Mortality in Adult Surgical Traumatic Brain Injury: A Tertiary Indonesian Cohort Study Vandy Ikra; Trijoso Permono; Theodorus
Sriwijaya Journal of Surgery Vol. 9 No. 1 (2026): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v9i1.150

Abstract

Introduction: Computed tomography (CT) classification anchors surgical triage in traumatic brain injury (TBI), but contemporary Indonesian data on the prognostic performance of the Marshall CT score in surgically managed patients are scarce. Methods: An observational retrospective cohort study was conducted at Dr. Mohammad Hoesin Central General Hospital, Palembang. Consecutive adult surgical TBI patients operated on between January 2023 and December 2025 were enrolled. Marshall CT categories were assigned from non-contrast head CT scans by two independent raters (κ = 0.87). The primary outcome was in-hospital mortality. We quantified the association between Marshall score and in-hospital mortality using Spearman rank correlation, point-biserial correlation, penalised L2 logistic regression, and ROC analysis. Results: Thirty-six patients met the inclusion criteria (75.0% male; median age 25 years). In-hospital mortality was 19.4% (7/36; 95% CI 9.8–35.0%). Spearman correlation between Marshall score and mortality was ρ = 0.532 (95% CI 0.245–0.731, p = 0.001). Marshall category was an independent predictor in penalised logistic regression (adjusted OR 3.12, 95% CI 1.63–4.41; p = 0.013). ROC AUC was 0.852 (95% CI 0.724–0.960), numerically superior to admission GCS AUC of 0.778 (DeLong p = 0.298). Conclusion: Marshall CT classification is an independent, point-of-CT predictor of in-hospital mortality after surgery for TBI in an Indonesian tertiary cohort. Integration into structured operative triage may enhance early risk stratification.
Open Reduction and Internal Fixation of a Displaced Both-Bone Forearm Fracture in a Child Using Oversized Tubular Implants in a Resource-Limited Regional Hospital: A Case Report I Gusti Putu Agung Pratama Putra
Sriwijaya Journal of Surgery Vol. 9 No. 1 (2026): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v9i1.151

Abstract

Introduction. Both-bone diaphyseal fractures of the forearm are among the most common injuries of childhood, and the majority are successfully managed by closed reduction and cast immobilisation. Operative fixation is reserved for irreducible, unstable, open, or markedly displaced fractures, and is favoured in older children whose capacity to remodel diaphyseal deformity is limited. In peripheral and regional hospitals the surgeon may face an additional, under-reported obstacle: an incomplete implant inventory that offers neither the ideal plate dimensions nor the full range of screw calibers. Case presentation. We report a 12-year-old boy who sustained a closed, displaced fracture of the middle third of the left radius and ulna after a fall on the outstretched hand at school. Examination demonstrated forearm deformity, swelling, tenderness and crepitus, with an intact distal neurovascular status. Radiographs confirmed displaced both-bone diaphyseal fractures with angulation. Because the only implants available in the regional setting were relatively oversized tubular plates and a limited selection of screws, the operating surgeon adapted the technique while preserving the principles of anatomical reduction and stable fixation, performing open reduction and internal fixation of both bones. The postoperative course was uneventful; serial radiographs showed progressive consolidation, and the implants were electively removed at twelve months, revealing united bone without refracture. Conclusion. Open reduction and internal fixation can achieve anatomical union of a paediatric both-bone forearm fracture even when only suboptimal implants are available, provided reduction quality and construct stability are respected. Adaptive surgical judgement is central to safe orthopaedic practice in resource-limited regional settings.
CORA-Based Single-Stage Double-Level Corrective Osteotomy for Pediatric Distal Tibiofibular Malunion with Multiplanar Valgus Ankle Deformity: A Case Report Totok Siswanto; Udi Heru Nefihancoro; Muhammad Rama Anshorie
Sriwijaya Journal of Surgery Vol. 9 No. 1 (2026): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v9i1.152

Abstract

Introduction. Distal tibiofibular malunion in the skeletally immature patient can generate a progressive multiplanar valgus ankle deformity that alters joint mechanics and threatens long-term function. Correction is especially demanding after neglected, non-medical treatment, which remains common in low- and middle-income settings. Case Presentation. A 13-year-old boy presented with a one-year history of progressive valgus deformity of the right ankle following a road-traffic injury initially managed by a traditional bone setter without radiographs. Imaging confirmed distal tibiofibular malunion with center of rotation of angulation (CORA) values of 16.9° in the coronal plane and 18.1° in the sagittal plane; the tibial anterior surface (TAS) angle was 76.4° and the tibial lateral surface (TLS) angle was 76.0°. A single-stage, CORA-based double-level closing-wedge osteotomy of the distal fibula and distal tibia was performed, stabilized with a one-third tubular plate and a distal tibial T-locking plate. The TAS improved to 93.0° and the TLS to 84.0°. At one-year follow-up the patient showed bony union, improved ankle motion, restored mechanical alignment, and painless ambulation without complications. Conclusion. CORA-guided single-stage double-level osteotomy with stable internal fixation can restore alignment, ankle congruity, and function in pediatric distal tibiofibular malunion with multiplanar valgus deformity. Early orthopedic evaluation and timely correction are essential to prevent long-term disability.

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