ABSTRAKLatar Belakang: Kebocoran anastomosis adalah komplikasi yang dapat terjadi
pasca dilakukannya reduksi manual, reseksi dan anastomosis end-to-end pada
kasus intususepsi. Faktor-faktor yang mempengaruhi kebocoran anastomosis
antara lain teknik operator, kondisi lokal usus, kondisi umum pasien dan grading
kolagen yang terbentuk pada proses penyembuhan luka.
Tujuan: Mengetahui pengaruh perubahan grading kolagen usus pasca reseksi
anastomosis terhadap kebocoran pada kasus intususepsi.
Metode: Dua puluh satu tikus Sprague-dawley dilakukan laparatomi untuk dibuat
model intususepsi (IN). Setelah 45 menit dilakukan destrangulasi selama 10
menit, dinilai adanya nekrosis dan dilanjutkan reseksi anastomosis. Tikus dibagi
menjadi 3 kelompok, kelompok A : reseksi anastomosis pada batas usus yang
nekrosis, kelompok B : reseksi anastomosis pada batas usus yang mengalami
trombosis pembuluh darah mesenteriumnya, dan kelompok C : reseksi
anastomosis pada batas usus yang sehat. Sampel usus yang direseksi diperiksa
secara Histopatologi untuk menilai grading kolagen. Setelah 5 hari dilakukan
laparatomi ulang, dinilai secara subjektif ada tidaknya kebocoran anastomosis,
lalu diambil sampel segmen anastomosis usus untuk dinilai kembali grading
kolagennya. Diharapkan jika terjadi kenaikan grading kolagen, anastomosis akan
paten, sebaliknya jika terjadi penurunan akan terjadi perforasi.
Hasil: Kelompok A: grading kolagen menurun dengan perforasi 6 (85,7%),
grading kolagen tetap tanpa perforasi 1 (14,2%). Kelompok B: grading kolagen
menurun dengan perforasi 2 (28,6%), tetap dengan perforasi 1 (14,3%),
meningkat tanpa perforasi 4 (42,9%). Kelompok C: grading kolagen meningkat
tanpa perforasi 5 (71,4%), menetap tanpa perforasi 2 (28,6%).
Kesimpulan: Terdapat perubahan grading kolagen pasca reseksi anastomosis
usus yang mempengaruhi tingkat kebocoran anastomosis pada kasus intususepsi
ABSTRACTBackground: Anastomosis leakage is a common complication following manual
reduction, resection and end-to-end anastomosis in treating intussusceptions.
Factors influencing the anastomosis leakage such as surgeon?s technique, local
bowel condition, systemic condition of patients and the concentration of collagen
in the bowel tissue during the anastomosis healing.
Aim: To study the effect of collagen concentration changes after resection and
anastomosis procedure, in relation to the anastomosis leakages in intussusceptions
case.
Methods: 21 Sprague-dawley rats were performed laparotomy to create the
intussusception model (IN). The IN models were applied for 45 minute, after the
bowel considered necrotic, destrangulation were performed for 10 minutes
continued with resection and anastomosis on 3 group of resection margin: A on
necrotic margin of bowel, B: on the thrombotic mesenterium vessel margin, C: on
normal bowel margin. Resected bowels were sent for histopathology examination
of collagen concentrations. After 5 days, another laparotomy was performed and
the anastomosis leakages were subjectively assessed. The anastomosed segments
were sampled for collagen concentration and grade.
Results: In study group A the collagen grading were found to be decreased with 6
leakages occurred (85.7%) and 1 subject (14.2%) with stable collagen grading and
no leakages. From group B, subjects with decreased collagen and leakages were 2
(28.6%), and 1 subjects (14.3%) were stable in grading with leakages, and 4
subjects (42.9%) with increased collagen without leakages. In Group C, 5 rats
(71.4%) had increased collagens without leakages, and 2 rats were at stable
collagen grade without leakages.
Conclusion: There were collagen grade changes in bowel anastomosis that affect
the extent of leakages in intussusceptions case