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Situmorang, Indah
Evaluasi keluaran dari operasi koreksi yang ditunda untuk cedera duktus bilier pada tindakan laparoskopi kolesistektomi di Rumah Sakit Cipto Mangunkusumo periode Juni 2010-Juni 2015 = Outcome after late surgical repair for bile duct injury following laparoscopic cholecystectomy in Cipto Mangunkusumo hospital from June 2010-June 2015
"Latar belakang: Cedera duktus bilier sewaktu operasi laparoskopi kolesistektomi berpotensi menimbulkan masalah untuk pasien dan ahli bedahnya. Rekonstruksi duktus bilier cukuplah sulit dimana diagnosis dini dan tatalaksana yang tepat diperlukan untuk mencegah morbiditas lanjut dan komplikasi yang mengancam jiwa. Operasi koreksi oleh ahli bedah hepatobilier yang berpengalaman di rumah sakit pusat rujukan penting untuk menjamin keberhasilan rekonstruksi.
Metode: Sepanjang Juni 2010 hingga Juni 2015 terdapat 7 kasus cedera saluran bilier. Dilakukan penelitian secera retrospektif, mengevaluasi karakteristik, tindakan dan keluaran dari operasi rekonstruksi.
Hasil: Satu dari 7 kasus cedera duktus bilier ditangani secara endoskopi, selebihnya menjalani pembedahan. Lima kasus (83,3%) menjalani operasi koreksi yang ditunda. Mean interval dari waktu terjadinya cedera hingga saat rujukan adalah 45 hari (median 45 hari). Mean interval dari waktu terjadinya cedera hingga operasi rekonstruksi adalah 182 hari (median 65 hari). Semua pasien mengalami biloma, dua pasien telah dilakukan drainase sebelum dirujuk. Satu pasien datang dengan ikterus dan 3 pasien mengalami peningkatan kadar bilirubin. Berdasarkan kolangiografi pra operasi; dua pasien dengan cedera Strassberg E3 dan satu pasien dengan cedera Strassberg E1. Dua pasien lain masing-masing mengalami cedera Strassberg C dan D. Pada semua pasien dilakukan rekonstruksi hepatikoyeyunostomi Roux en Y dan stent internal dipasang pada 2 pasien. Stent internal ini dilepas masing-masing pada hari post operatif ke-18 dan ke-20. Rerata durasi operasi adalah 4 jam 42 menit. Rerata durasi rawat inap adalah 38,2 hari. Hanya satu pasien yang mengalami morbiditas pasca operasi. Pasien ini memerlukan tindakan operasi untuk memperbaiki luka operasi yang terbuka. Dilakukan pemantauan pasca operasi selama 6-24 bulan. Semua pasein tidak ada yang mengalami ikterus maupun kolangitis pada periode tersebut.
Simpulan: Tindakan koreksi operatif pada cedera duktus bilier akan menunjukkan hasil yang baik bila dilakukan oleh ahli bedah hepatobilier yang berpengalaman. Hepatikoyeyunostomi merupakan tindakan yang terbaik untuk mengembalikan kontinuitas aliran bilier. Follow up jangka panjang tetap dibutuhkan untuk melihat keluaran pada seluruh pasien.
Background: Bile duct injury (BDI) during laparoscopic cholecystectomy (LC) procedure bears problem for the patients and the surgeon. Biliary reconstruction is often challenging while prompt diagnosis and proper treatment are needed to prevent long term morbidity and life threatenting complications. Surgical repair by an experienced hepatobiliary surgeon in a tertiary care is important to ensure the success of the reconstruction.
Methods: From June 2010 to June 2015 there are 7 BDI. We conduct a retrospective study by evaluating the characteristic, type of surgery and the outcome.
Results: One out of 7 BDI cases were managed endoscopically. The rest had surgical reconstruction. Five cases (83.3%) had a late surgical repair. The mean interval from the time of BDI to referral was 45 days (median 45 days). The mean interval from the time of BDI to the reconstruction surgery was 182 days (median 65 days). All of the patients had biloma, two patients had drainage prior of the referral. One patient had clinical jaundice, three patients with slightly elevated bilirubin level. Based on the cholangiography studies prior of the surgery, two patients had Strassberg E3 injury and 1 patient had Strassberg E1 injury. Two other patients each had Strassberg C and D injury . All of the patients had a hepaticojejunostomy Roux en Y reconstruction; an internal stent was placed in two patients. The internal stent were removed on POD 18 and POD 20. Mean operative time was 4 hours 42 minutes. Mean hospital stay was 38.2 days. Only one patient developed a post operative morbidity. She needed another surgery to repair the burst abdomen. The follow up period range from 6-24 months. All patients did not develop jaundice or cholangitis during that period.
Conclusion: Surgical repair for BDI will show a better outcome when being done by an experienced hepatobilliary surgeon. Hepaticojejunostomy offers the best chance to restore the continuity of the biliary flow. A long term follow up still needed to see the overall result on these patients."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2016
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UI - Tugas Akhir  Universitas Indonesia Library
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Raya Henri Batubara
Kolesistektomi laparoskopi di Rumah Sakit Cipto Mangunkusumo 2014 : Studi retrospektif observasional = Laparoscopic cholecystectomy experience at Cipto Mangunkusumo Hospital 2014 : A retrospective study
"ABSTRAK
Latar belakang: Kolesistektomi merupakan tindakan abdomen tersering dan saat ini
kolesistektomi laparoskopi (KL) merupakan baku emas dan telah dilakukan pada 90% kasus
kolesistitis simtomatik. Tujuan penelitian ini adalah untuk mengetahui hasil KL di RSCM,
Jakarta.
Metode: Penelitian retrospektif observasional ini menggunakan data dari departemen bedah
divisi digestif RSCM dari bulan Januari hingga Desember 2014. Partisipan penelitian ini
adalah pria atau wanita yang berusia 23-66 tahun yang menjalani KL. Tindakan bedah
dilakukan baik berupa perawatan 1 hari (one day care (ODC)) maupun elektif. Data yang
dikaji adalah temuan preoperatif dan intraoperatif, durasi operasi, lama rawat inap, dan angka
konversi ke tindakan kolesistektomi terbuka (open). Kemudian kami menganalisis faktor
yang mempengaruhi angka konversi.
Hasil: Jumlah pasien yang masuk inklusi adalah 90 orang. Usia rata-rata 43,9 tahun (SE=1,26
tahun) dengan jumlah pasien wanita 61 orang (67,8%). Median durasi operasi adalah 90±36,9
menit dimana pasien yang konversi membutuhkan operasi lebih dari 2 jam lebih banyak
(12% vs 1,5%), namun tidak bermakna secara statistik (p= 0,63). Median lama rawat inap
adalah 9±27.2 hari dan meningkat bermakna pada kasus yag konversi (24±9 hari, p = 0.011).
Median lama pre-operasi = 7±26,8 hari, dan pasca-operasi = 2±3.8 hari, dengan 13,3% pasien
dilakukan endoscopic retrograde cholangio-pancreatography (ERCP) sebelum KL. Cedera
duktus biliaris komunis (CBDK) ditemukan pada 3 kasus (3,33%). Konversi menjadi
laparotomi dibutuhkan pada 4,44% kasus. Faktor yang mempengaruhi angka konversi hanya
pada kasus adhesi (RR (95%IK) = 25,7 (2,4-273,5); p=0,007.
Kesimpulan temuan: kolesistektomi laparoskopi menawarkan lama rawat inap yang lebih
singkat. Durasi operasi pendek dan prosedur ini standard, aman, dan efektif di institusi kami. ABSTRACT
Background: Cholecystectomy is the most frequently performed abdominal operation and
currently laparoscopic cholecystectomy (LC) is considered gold standard being performed in
90% cases of symptomatic gallstones. The aim of the study was to determine results obtained
with LC at our hospital, RSCM, Jakarta.
Methods: This retrospective observational study was conducted in digestive divison in
surgery department of RSCM using data from January to December 2014. The study
participants were patients of both gender aged 23?66 years undergoing LC. Surgery was
performed either in one day care (ODC) or elective schedule. Demographic variables,
preoperative and intraoperative findings, mean operation time, hospital stay, and conversion
rate were evaluated. Factors influencing rate of conversion were also studied.
Results: A total of 90 patients were included. Mean age was 43.9 years (SE=1.26 years) with
a female 61 (67.8%). Median operative time was 90±36.9 minutes which converted cases
patient needed to operate in more than 2 hours (12% vs 1.5%), but not statistically significant
(p= 0.63). Median hospital stay was 9±27.2 days that significantly increased in converted
cases (24±9 days, p-value= 0.011). Median of pre-operation = 7±26.8 days, and postoperation
= 2±3.8 days, with 13.3% patients underwent endoscopic retrograde cholangiopancreatography
(ERCP). Common bile duct injury (CBDI) was found in 3 cases (3.33%).
Conversion to laparotomy was required in 4.44% cases. Factors that influenced the rate of
conversion included was only adhesion (RR (95%CI) = 25.7 (2.4-273.5), p=0.007.
Findings: Laparoscopic cholecystectomy offers shorter hospital stay. The operative time is
short and procedure is standard, safe and effective in our institution.;Background: Cholecystectomy is the most frequently performed abdominal operation and
currently laparoscopic cholecystectomy (LC) is considered gold standard being performed in
90% cases of symptomatic gallstones. The aim of the study was to determine results obtained
with LC at our hospital, RSCM, Jakarta.
Methods: This retrospective observational study was conducted in digestive divison in
surgery department of RSCM using data from January to December 2014. The study
participants were patients of both gender aged 23?66 years undergoing LC. Surgery was
performed either in one day care (ODC) or elective schedule. Demographic variables,
preoperative and intraoperative findings, mean operation time, hospital stay, and conversion
rate were evaluated. Factors influencing rate of conversion were also studied.
Results: A total of 90 patients were included. Mean age was 43.9 years (SE=1.26 years) with
a female 61 (67.8%). Median operative time was 90±36.9 minutes which converted cases
patient needed to operate in more than 2 hours (12% vs 1.5%), but not statistically significant
(p= 0.63). Median hospital stay was 9±27.2 days that significantly increased in converted
cases (24±9 days, p-value= 0.011). Median of pre-operation = 7±26.8 days, and postoperation
= 2±3.8 days, with 13.3% patients underwent endoscopic retrograde cholangiopancreatography
(ERCP). Common bile duct injury (CBDI) was found in 3 cases (3.33%).
Conversion to laparotomy was required in 4.44% cases. Factors that influenced the rate of
conversion included was only adhesion (RR (95%CI) = 25.7 (2.4-273.5), p=0.007.
Findings: Laparoscopic cholecystectomy offers shorter hospital stay. The operative time is
short and procedure is standard, safe and effective in our institution.;Background: Cholecystectomy is the most frequently performed abdominal operation and
currently laparoscopic cholecystectomy (LC) is considered gold standard being performed in
90% cases of symptomatic gallstones. The aim of the study was to determine results obtained
with LC at our hospital, RSCM, Jakarta.
Methods: This retrospective observational study was conducted in digestive divison in
surgery department of RSCM using data from January to December 2014. The study
participants were patients of both gender aged 23?66 years undergoing LC. Surgery was
performed either in one day care (ODC) or elective schedule. Demographic variables,
preoperative and intraoperative findings, mean operation time, hospital stay, and conversion
rate were evaluated. Factors influencing rate of conversion were also studied.
Results: A total of 90 patients were included. Mean age was 43.9 years (SE=1.26 years) with
a female 61 (67.8%). Median operative time was 90±36.9 minutes which converted cases
patient needed to operate in more than 2 hours (12% vs 1.5%), but not statistically significant
(p= 0.63). Median hospital stay was 9±27.2 days that significantly increased in converted
cases (24±9 days, p-value= 0.011). Median of pre-operation = 7±26.8 days, and postoperation
= 2±3.8 days, with 13.3% patients underwent endoscopic retrograde cholangiopancreatography
(ERCP). Common bile duct injury (CBDI) was found in 3 cases (3.33%).
Conversion to laparotomy was required in 4.44% cases. Factors that influenced the rate of
conversion included was only adhesion (RR (95%CI) = 25.7 (2.4-273.5), p=0.007.
Findings: Laparoscopic cholecystectomy offers shorter hospital stay. The operative time is
short and procedure is standard, safe and effective in our institution.;Background: Cholecystectomy is the most frequently performed abdominal operation and
currently laparoscopic cholecystectomy (LC) is considered gold standard being performed in
90% cases of symptomatic gallstones. The aim of the study was to determine results obtained
with LC at our hospital, RSCM, Jakarta.
Methods: This retrospective observational study was conducted in digestive divison in
surgery department of RSCM using data from January to December 2014. The study
participants were patients of both gender aged 23?66 years undergoing LC. Surgery was
performed either in one day care (ODC) or elective schedule. Demographic variables,
preoperative and intraoperative findings, mean operation time, hospital stay, and conversion
rate were evaluated. Factors influencing rate of conversion were also studied.
Results: A total of 90 patients were included. Mean age was 43.9 years (SE=1.26 years) with
a female 61 (67.8%). Median operative time was 90±36.9 minutes which converted cases
patient needed to operate in more than 2 hours (12% vs 1.5%), but not statistically significant
(p= 0.63). Median hospital stay was 9±27.2 days that significantly increased in converted
cases (24±9 days, p-value= 0.011). Median of pre-operation = 7±26.8 days, and postoperation
= 2±3.8 days, with 13.3% patients underwent endoscopic retrograde cholangiopancreatography
(ERCP). Common bile duct injury (CBDI) was found in 3 cases (3.33%).
Conversion to laparotomy was required in 4.44% cases. Factors that influenced the rate of
conversion included was only adhesion (RR (95%CI) = 25.7 (2.4-273.5), p=0.007.
Findings: Laparoscopic cholecystectomy offers shorter hospital stay. The operative time is
short and procedure is standard, safe and effective in our institution.;Background: Cholecystectomy is the most frequently performed abdominal operation and
currently laparoscopic cholecystectomy (LC) is considered gold standard being performed in
90% cases of symptomatic gallstones. The aim of the study was to determine results obtained
with LC at our hospital, RSCM, Jakarta.
Methods: This retrospective observational study was conducted in digestive divison in
surgery department of RSCM using data from January to December 2014. The study
participants were patients of both gender aged 23?66 years undergoing LC. Surgery was
performed either in one day care (ODC) or elective schedule. Demographic variables,
preoperative and intraoperative findings, mean operation time, hospital stay, and conversion
rate were evaluated. Factors influencing rate of conversion were also studied.
Results: A total of 90 patients were included. Mean age was 43.9 years (SE=1.26 years) with
a female 61 (67.8%). Median operative time was 90±36.9 minutes which converted cases
patient needed to operate in more than 2 hours (12% vs 1.5%), but not statistically significant
(p= 0.63). Median hospital stay was 9±27.2 days that significantly increased in converted
cases (24±9 days, p-value= 0.011). Median of pre-operation = 7±26.8 days, and postoperation
= 2±3.8 days, with 13.3% patients underwent endoscopic retrograde cholangiopancreatography
(ERCP). Common bile duct injury (CBDI) was found in 3 cases (3.33%).
Conversion to laparotomy was required in 4.44% cases. Factors that influenced the rate of
conversion included was only adhesion (RR (95%CI) = 25.7 (2.4-273.5), p=0.007.
Findings: Laparoscopic cholecystectomy offers shorter hospital stay. The operative time is
short and procedure is standard, safe and effective in our institution."
Fakultas Kedokteran Universitas Indonesia, 2015
SP-PDF
UI - Tugas Akhir  Universitas Indonesia Library
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Natasya Dwi Amalia
Analisis Asuhan Keperawatan pada Pasien Kolelitiasis Pre Laparoskopi Kolesistektomi dengan Penerapan Intervensi Keperawatan Relaksasi Napas Dalam di Ruang Rawat Lantai 4 Zona B Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo Jakarta = Analysis of Nursing Care in Cholelithiasis Patient Pre-Laparoscopic Cholecystectomy with Deep Breathing Relaxation Nursing Intervention in Surgical Ward of RSUPN Dr. Cipto Mangunkusumo Jakarta
"Kolelitiasis menjadi salah satu masalah kesehatan sistem gastrointestinal utama di tingkat global. Hal ini disebabkan karena adanya perubahan gaya hidup masyarakat meliputi penurunan aktivitas fisik dan pola diet yang kurang tepat. Salah satu penatalaksanaan pembedahan yang dilakukan pada pasien kolelitiasis ialah laparoskopi kolesistektomi. Karya Ilmiah Akhir Ners ini bertujuan untuk menyajikan hasil analisis asuhan keperawatan pada pasien kolelitiasis pre laparoskopi kolesistektomi dengan menerapkan intervensi keperawatan teknik relaksasi napas dalam guna mengatasi ansietas preoperasi. Adapun intervensi lain yang direkomendasikan berdasar pada kajian praktik berbasis bukti meliputi penerapan intervensi penggunaan terapi musik guna menurunkan kecemasan pada pasien pra pembedahan laparoskopi kolesistektomi. Penggabungan penerapan relaksasi napas dalam dan terapi musikdiharapkan dapat diaplikasikan oleh perawat di ruangan khususnya pada pasien yang akan menjalankan operasi laparoskopi kolesistektomi untuk mengatasi masalah ansietas preoperasi.

Cholelithiasis is one of the major health problems of gastrointestinal system at the global level. This is due to changes in peoples lifestyles including decreased physical activity and inappropriate dietary patterns. One of the surgical treatments performed on cholelithiasis patients is laparoscopic cholecystectomy. The aims of this study is to analyse the nursing care of pre-laparoscopic cholecystectomy patients by applying deep breathing relaxation intervention to overcome the preoperative anxiety problem. Besides that, another intervention that is recommended based on evidence-based practice studies is the use of intervention of music therapy to reduce anxiety in pre-laparoscopic cholecystectomy patients. Combining the application of deep breathing relaxation and music therapy is expected to be applied by nurses, especially for patients who will undergo laparoscopic cholecystectomy to overcome the problem of preoperative anxiety."
Depok: Fakultas Ilmu Keperawatan Universitas Indonesia, 2020
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UI - Tugas Akhir  Universitas Indonesia Library
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Rony
Validasi penilaian kantung empedu intraoperatif 10 poin (G10) pada kolesistektomi laparaskopik di RSUPN dr. Cipto Mangunkusumo = The validation of 10 points intraoperative gallbladder scoring system (G10) in laparoscopic cholecystectomy at RSUPN dr. Cipto Mangunkusumo
"Latar Belakang : Penatalaksanaan kolesistektomi laparoskopik telah menjadi baku emas untuk penanganan kolesistolitiasis simptomatik di RS Dr. Cipto Mangunkusumo (RSCM), sedangkan sampai saat ini belum ada sistem penilaian kantung empedu intraoperatif yang diterapkan saat operasi. Penilaian kantong empedu intraoperatif yang sesuai dapat menggambarkan tingkat kesulitan kolesistektomi laparaskopik secara objektif dan akan berpengaruh terhadap pemilihan teknik kolesistektomi laparaskopik yang tepat untuk mencegah terjadinya trauma bilier. Penelitian ini bertujuan mengevaluasi nilai G10 dan mencari hubungan dengan teknik operasi pada pasien yang sudah dilakukan kolesistektomi laparaskopik di RSCM.
Metode : Dilakukan penelitian retrospektif pada subjek yang telah dilakukan kolesistektomi laparaskopik pada Januari 2019 sampai Desember 2019 di institusi kami. Kami mengumpulkan karakteristik subjek berdasarkan catatan medis rumah sakit. Kami menentukan nilai G10 dan teknik operasi berdasarkan dokumentasi gambar intraoperatif dan laporan bedah. Data nilai G10 dan klasifikasi teknik operasi dilakukan uji non parametrik Mann-Whitney untuk melihat perbedaannya. Dilakukan uji statistik Kendalls Tau untuk menilai hubungan antara nilai G10 dengan prosedur bailout. Dilakukan uji ROC untuk melihat sensitifitas dan spesifisitas nilai G10 terhadap prosedur bailout, kemudian ditentukan nilai cut-off nya.
Hasil : 99 subjek Indonesia, usia rata-rata 49,80+13,421 tahun, menjalani kolesistektomi laparaskopik di Rumah Sakit Umum Dr.Cipto Mangunkusumo selama satu tahun. Sebagian besar diagnosis adalah kolesistolitiasis tanpa kolesistitis (68 subjek, 68,8%) dan kolesistitis kronis (23 subjek, 23,2%). Pembedahan elektif dilakuan pada 91 subjek (91,9%). Median nilai G10 adalah 2 (rentang 1-8). CVS dilakukan pada 81 subjek (81,8%), sedangkan 18 subjek dikelola dengan prosedur bailout (18,2%), terdiri dari 14 subjek dilakukan FF (14,2%), 2 subjek SC (2,0%) dan 2 subjek konversi operasi terbuka (2,0%). Nilai median G10 berbeda pada subjek yang menjalani CVS (1, rentang 1-6), FF (3, rentang 2-6), SC (5, rentang 5-5) dan konversi terbuka (6,5, rentang 5-8). Ada perbedaan median nilai G10 (<0,001) antara kelompok yang dilakukan CVS (1, rentang 1-6) dengan kelompok yang dilakukan prosedur bailout (4, rentang 2-8). Terdapat hubungan antara nilai G10 dengan prosedur bailout (<0,001, +0,478). Akurasi nilai G10 untuk memprediksi prosedur bailout dinilai dengan menggunakan kurva receiver operating characteristic (ROC) (<0,001, AUC 0,865) dan didapatkan cut-off point yang optimal untuk melakukan prosedur bailout adalah 2,5 (x2, p=0,000019).
Kesimpulan : Studi ini menunjukkan bahwa G10 adalah sistem penilaian kandung empedu intraoperatif yang objektif dan dapat diterapkan saat melakukan kolesistektomi laparaskopik. Nilai G10 berhubungan dengan prosedur bailout. Nilai 2,5 adalah cut-off point yang optimal untuk melakukan prosedur bailout saat kolesistektomi laparaskopik.
Introduction. Laparoscopic cholecystectomy has become a gold standard for symptomatic cholecystolithiasis management at Dr. Cipto Mangunkusumo Hospital (RSCM), while there is no intraoperative gallbladder assessment system applied during laparoscopic cholecystectomy. An appropriate intraoperative gallbladder assessment system can describe objectively the degree of difficulty in laparascopic cholecystectomy and fascilitate appropriate surgical decision-making to prevent biliary injury. This study aims to validate the intraoperative G10 scoring system and look for relationships with laparoscopic cholecystectomy techniques already performed at RSCM.
Method. A cross sectional study was established to the subjects had performed laparascopic cholecystectomy between Januari 2019 and December 2019. We collected characteristic of subjects based on medical records. We assessed the G10 scoring system and operation technique based on the documentation of intraoperatif images and surgical reports.
Results. Ninety-nine indonesian subjects, mean age 49.80+13.421 yrs, underwent laparascopic cholecystectomy at RSCM for a year. Most diagnosis were symptomatic cholecystolithiasis (67.7%) and chronic cholecystitis (23.2 %). Most of surgery was elective (91.9%). The median G10 score was 2 (range 1-8). CVS was feasible in 81.8%, whereas 18.2% cases were managed by bailout procedure. Of those, 14.2 % cases underwent FF, 2% SC and 2% open surgery conversion. The median G10 score differs among subjects undergoing CVS (median 1, range 1-6), FF (median 3, range 2-6), SC (median 5, range 5-5) and open conversion (median 6.5, range 5-8). There was a difference in the G10 score (<0.001) between the groups that performed CVS (median 1, range 1-6) and the groups that performed bailout procedures (median 4, ranges 2-8). There is a relationship between the G10 score and the bailout procedure (<0.001,+0.487). The accuracy of the G10 score to predict the bailout was assessed using a ROC curve (<0.001, AUC 0.865) and the optimal cut-off point to perform a bailout procedure was 2.5 (x2, p=0.000019).
Conclusion. The G10 is an objective and applicable intraoperative gallbladder assessment system when performing laparoscopic cholecystectomy. The G10 score has a relationship with the bailout procedure during laparascopic cholecystectomy. G10 score 2.5 is the optimal cut-off point for a bailout procedure when performing laparoscopic cholecystectomy."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2020
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UI - Tugas Akhir  Universitas Indonesia Library
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Nila Wahyuningsih
Analisis asuhan keperawatan pada pasien kolelitiasis dengan penerapan intervensi mobilisasi post operasi laparoskopi kolesistektomi = Nursing care analysis in cholelithiasis patients with the application of post laparoscopic early mobilization of cholecystectomy
"Kolelitiasis merupakan penyakit kandung empedu dimana terdapat endapan satu atau lebih komponen diantaranya empedu, kolesterol, billirubin, garam empedu, kalsium, protein, asam lemak, dan fosfolipid yang membentuk suatu senyawa padat yang disebut batu empedu. Laparoskopi kolesistektomi merupakan salah satu prosedur pembedahan yang ditujukan sebagai upaya kuratif untuk mengatasi masalah penyumbatan saluran empedu, yaitu dengan mengangkat kandung empedu. Asuhan keperawatan dilakukan untuk mengatasi masalah keperawatan yang terjadi pada pasien post laparoskopi kolesistektomi. Penulisan karya ilmiah bertujuan untuk menganalis asuhan keperawatan yang dilakukan pada pasien kolelitiasis dengan penerapan mobilisasi dini post laparoskopi kolesistektomi. Hasil evaluasi didapatkan masa pemulihan yang lebih cepat dengan masa rawat yang singkat, nyeri lebih cepat teratasi, dan penyembuhan luka yang baik. Mobilisasi dini sangat disarankan untuk diterapkan sesegera mungkin bagi para pasien usai dilakukan pembedahan untuk menghindari terjadinya perlambatan pemulihan pasca bedah.
Cholelithiasis is a gallbladder disease where there is one or more deposits of the bile, cholesterol, billirubin, bile salt, calcium, proteins, fatty acids, and phospholipids that form a solid compound called gallstones. Laparoscopic cholecystectomy is one of the surgical procedures aimed at curative efforts to overcome the problem of bile duct blockage, by removing the gallbladder. Nursing care is done to overcome the nursing problems of the patient who have had a laparoscopic cholecystectomy. Scientific writing aims to analize nursing care conducted in cholelithiasis patients with the application of early mobilization post laparoscopic cholecystectomy. The results of the evaluation are obtained faster recovery time with short length of stay, faster pain resolved, and good wound healing. Early mobilization is recommended to be carried out as soon as possible for patients after surgery to avoid slowing down post-surgical recovery."
Depok: Fakultas Ilmu Keperawatan Universitas Indonesia, 2020
PR-pdf
UI - Tugas Akhir  Universitas Indonesia Library
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Astuty
Pengembangan model penjadwalan pelayanan operasi elektif di Instalasi Kamar Operasi RSUD Pasar Rebo
"Pelayanan kamar operasi merupakan salah satu bentuk pelayanan yang sangat mempengaruhi tampilan suatu rumah sakit. Seiring dengan ilmu pengetahuan dan teknologi, kegiatan bedah menjadi bentuk pelayanan kesehatan spesialistik yang mahal, jadi harus efisien pengelolaannya.
Instalasi Kamar Operasi RSUD Pasar Rebo mempunyai 4 kamar operasi yang melayani bedah cito dan elektif. Dengan disatukannya pelayanan tindakan bedah cito dan elektif di instalasi kamar operasi ini, tindakan bedah elektif sering diundur pelaksanaannya karena harus mendahulukan pelaksanaan tindakan bedah cito yang mendapat prioritas utama dan adakalanya bedah elektif terpaksa ditunda/dibatalkan pelaksanaannya. Kapasitas waktu yang tersedia dari jam 8.00 pagi s.d 14.00 siang juga pada kenyataannya tidak dimanfaatkan seefisien karena belum adanya sistem penjadwalan operasi yang baik, pemakaian kamar operasi selalu dimulai diatas jam 8.00 pagi sehingga waktu kerja yang terbuang dimasing-masing kamar operasi rata-rata 32,87% perhari.
Penelitian ini bertujuan untuk mengetahui gambaran/karakteristik sistem pelayanan tindakan bedah di Instalasi Kamar Operasi di RSUD Pasar Rebo dan membuat tehnik penjadwalan yang sesuai sehingga produk yang dihasilkan dapat efisien dan optimal. Penelitian ini merupakan penelitian cross sectional dan melakukan analisa kuantitatif terhadap data sekunder untuk membuat model kuantitatif dan analisa deskriptif.
Dari hasil penelitian diketahui utilisasi kamar operasi sebesar 46,66% pada saat bedah cito masih dilakukan bersama-sama dengan bedah elektif. Lalu dari simulasi diperoleh besar utilisasi kamar operasi untuk bedah elektif (tanpa bedah cito) rata-rata sebesar 39,25% di setiap kamar operasi dengan 9 kasus perhari. Dengan simulasi juga dapat diketahui kapasitas optimal kamar operasi untuk mengerjakan bedah elektif sebanyak 18 kasus per hari. Dengan mengetahui kapasitas optimal masing-masing kamar operasi dan lama waktu operasi untuk masing-masing tindakan bedah dapat dibuat sistem penjadwalan yang sesuai untuk Instalasi kamar Operasi RSUD Pasar Rebo.
Dengan adanya penjadwalan dapat diketahui berapa besar kapasitas yang berlebih setiap hari dan disarankan membuat perencanaan untuk pemanfaatannya sehingga Instalasi Kamar Operasi dapat sebagai salah satu revenue center rumah sakit.
Developing a Model for Scheduling of Elective Surgery Service for The Surgery Theatre Installation of The Pasar Rebo HospitalSugery theatre service is one of the hospital services that make an image to the hospital performance. In line with advanced knowledge and technology, surgical operation become more expensive specialistic health service and need to be managed efficiently.
The Surgery Theatre Installation of The Pasar Rebo Hospital have four surgical theatres which serve surgical operations both emergency and elective surgery. As The Surgery Theatre Installation served surgical operations both emergency and elective surgery, resulting in postponement or cancellation of elective surgical operations. Allocated time to serve surgical operations is from 8.00 a.m to 2.00 p.m daily. This allocated time had not been utilized effectively because of unmanaged scheduling for surgical operations resulting in lost of worktime about 32,87% for each surgical theatre daily.
The purpose of this study was to describe characteristic of surgical service acheduling system of The Pasar Rebo Hospital and subsequently to develop a model to manage better through scheduling technique. This study was a cross sectional study with quantitative model related to scheduling of surgery services.
The result of this study showed that each surgical theatre utilization rate was about 46,6% when both emergency and elective surgical operations performed in those surgical theatres.
After performing simulation, utilization rate of elective surgery without emergency surgery was about 39,25% with 9 cases for each surgical theatre daily. In addition, optimal capacity of Sugery Theatre Installation was 18 cases daily. After knowing optimal capacity for each surgical theatre and average time for each surgical operation, a model of well managed scheduling system can be developed for The Surgery Theatre Installation of The Pasar Rebo Hospital.
After implementing well managed scheduling system, The Surgery Installation of The Pasar Rebo Hospital would be able to know daily capacity for each surgery theatre and develop a plan to utilize effectively each surgery theatre daily resulting in increasing revenue for The Pasar Rebo Hospital."
Depok: Universitas Indonesia, 2002
T438
UI - Tesis Membership  Universitas Indonesia Library
cover
Septo Sulistio
Instilasi ropivakain 0.375% intraperitonium sebagai ajuvan terapi nyeri pascalaparoskopi kolesistektomi = Intraperitoneal instillation of ropivacaine 0.375% as postlaparoscopy cholecystectomy pain therapy adjuvant
"[ABSTRAK
Latar Belakang : Laparoskopi kolesistektomi saat ini menjadi pilihan utama kasus batu kandung empedu simtomatik. Walaupun minimal, laporan mengenai nyeri abdomen dan nyeri bahu masih dirasakan pascalaparoskopi kolesistektomi. Nyeri ini muncul segera setelah operasi dan dapat bertahan selama 3 hari. Penelitian ini bertujuan untuk mengetahui efektivitas instilasi ropivakain 0.375% intraperitonium sebagai ajuvan terapi nyeri pascalaparoskopi kolesistektomi.
Metode : Penelitian ini adalah uji klinik acak tersamar ganda yang dikerjakan di Instalasi Bedah Pusat RSCM pada bulan November 2014 sampai April 2015. Subjek yang memenuhi kriteria dibagi menjadi kelompok ropivakain (R) (n=35) mendapat 40 mL ropivakain 0.375% dan kelompok NaCl (N) (n=33) mendapat 40 mL NaCl 0.9%. Peracikan regimen dikerjakan oleh orang yang berbeda dengan operator dan penilai. Tingkat nyeri statis, dinamis dan nyeri rujuk dinilai pada jam
ke-1, 6 dan 24 pascaoperasi. Waktu meminta analgetik tambahan pertama (petidin) juga dicatat. Data regimen yang diterima baru dibuka setelah pengumpulan data selesai.
Hasil : Secara statistik terdapat perbedaan bermakna pada proporsi nyeri statis jam pertama antara kelompok R dan N. Kelompok R cenderung memiliki nilai VAS lebih rendah (p=0.05;OR=0.453). Tidak terdapat perbedaan bermakna pada keseluruhan jenis nyeri yang dinilai dalam tiap-tiap waktu penilaian. Median waktu meminta petidin juga tidak berbeda antara kedua kelompok.
Simpulan: Instilasi ropivakain 0.375% intraperitonium tidak lebih efektif sebagai ajuvan terapi nyeri pascalaparoskopi kolesistektomi dibandingkan tanpa ajuvan.
ABSTRACT
Background: Laparoscopy cholecystectomy has been the preferred procedure for symptomatic cholelithiasis. Although less minimal, abdominal and shoulder pain are still reported. The pain rises after operation and persists for 3 days. The aim of this study was to determine the effect of intraperitoneal ropivacaine 0.375% as adjuvant in postlaparoscopy cholecystectomy pain therapy.
Method: This was a randomized, double blinded, clinical control trial that held in central operating theater Ciptomangunkusumo hospital during November 2014 until April 2015. Subjects divided into two groups. The ropivacaine (R) group (n=35) got 40 mL ropivacain 0.375% and the control (N) group (n=33) got NaCl 0.9% in same volume. Regiment was prepared by different personel from the operator and evaluator. Pain at rest, cough and shoulder pain were recorded in VAS at 1st, 6th and 24th hours postoperative. Time to get the first petidine dose was also recorded.
Result: Ropivacaine had higher proportion of mild pain at rest (VAS<4) at 1st hour (p=0.050; OR=0.453). There were no statistically significant difference for other pain proportions in any time measured. Median time to get first petidine dose did not differ between the two groups.
Conclusion: Intraperitoneal instillation of ropivacaine 0.375% as adjuvant in postlaparoscopy cholecystectomy pain therapy is not more effective than without adjuvant.;Background: Laparoscopy cholecystectomy has been the preferred procedure for symptomatic cholelithiasis. Although less minimal, abdominal and shoulder pain are still reported. The pain rises after operation and persists for 3 days. The aim of this study was to determine the effect of intraperitoneal ropivacaine 0.375% as adjuvant in postlaparoscopy cholecystectomy pain therapy.
Method: This was a randomized, double blinded, clinical control trial that held in central operating theater Ciptomangunkusumo hospital during November 2014 until April 2015. Subjects divided into two groups. The ropivacaine (R) group (n=35) got 40 mL ropivacain 0.375% and the control (N) group (n=33) got NaCl 0.9% in same volume. Regiment was prepared by different personel from the operator and evaluator. Pain at rest, cough and shoulder pain were recorded in VAS at 1st, 6th and 24th hours postoperative. Time to get the first petidine dose was also recorded.
Result: Ropivacaine had higher proportion of mild pain at rest (VAS<4) at 1st hour (p=0.050; OR=0.453). There were no statistically significant difference for other pain proportions in any time measured. Median time to get first petidine dose did not differ between the two groups.
Conclusion: Intraperitoneal instillation of ropivacaine 0.375% as adjuvant in postlaparoscopy cholecystectomy pain therapy is not more effective than without adjuvant., Background: Laparoscopy cholecystectomy has been the preferred procedure for symptomatic cholelithiasis. Although less minimal, abdominal and shoulder pain are still reported. The pain rises after operation and persists for 3 days. The aim of this study was to determine the effect of intraperitoneal ropivacaine 0.375% as adjuvant in postlaparoscopy cholecystectomy pain therapy.
Method: This was a randomized, double blinded, clinical control trial that held in central operating theater Ciptomangunkusumo hospital during November 2014 until April 2015. Subjects divided into two groups. The ropivacaine (R) group (n=35) got 40 mL ropivacain 0.375% and the control (N) group (n=33) got NaCl 0.9% in same volume. Regiment was prepared by different personel from the operator and evaluator. Pain at rest, cough and shoulder pain were recorded in VAS at 1st, 6th and 24th hours postoperative. Time to get the first petidine dose was also recorded.
Result: Ropivacaine had higher proportion of mild pain at rest (VAS<4) at 1st hour (p=0.050; OR=0.453). There were no statistically significant difference for other pain proportions in any time measured. Median time to get first petidine dose did not differ between the two groups.
Conclusion: Intraperitoneal instillation of ropivacaine 0.375% as adjuvant in postlaparoscopy cholecystectomy pain therapy is not more effective than without adjuvant.]"
Fakultas Kedokteran Universitas Indonesia, 2015
T58676
UI - Tesis Membership  Universitas Indonesia Library
cover
Desandra Puspita Nugraha
Efek larutan irigasi bersuhu dingin terhadap pembengkakan dan rasa nyeri pasca odontektomi = Effect of cold irrigation solution on swelling and pain after third molar surgery
"ABSTRACT
Latar belakang: Efek samping tindakan odontektomi yang sering terjadi adalah pembengkakan dan rasa nyeri.Banyak praktisitelah menggunakan terapi dingin untuk mengurangi pembengkakan dan rasa nyeri pasca odontektomi, namun masih sedikit dokter gigi yang menggunakan terapi dingin berupa larutan irigasi bersuhu dingin saat tindakan odontektomi. Tujuan: Mengevaluasi efek pemberian irigasi bersuhu dingin terhadap pembengkakan dan rasa nyeri pasca odontektomi. Metode penelitian:Studi prospektif pada pasien RSKGM FKG UI dengan gigi impaksi dan menjalani tindakan odontektomi. Pasien dibagi menjadi 2 kelompok, yaitu kelompok pasien yang mendapat perlakuan larutan irigasi bersuhu dingin dan kelompok kontrol larutan irigasi bersuhu kamar. Pembengkakan dan intensitas nyeri pasien pada kedua kelompok diukur dan dibandingkan pada hari H, ke-3, dan ke-7. Hasil: Terdapat perbedaan bermakna (p<0.05) antarapembengkakan pada kelompok pasien yang diberikan larutan irigasi bersuhu dingin dengan kelompok pasien yang diberikan larutan irigasi bersuhu kamar, namun tidak terdapat perbedaan bermakna (p>0.05) antara rasa nyeri pada kelompok pasien yang diberikan larutan irigasi bersuhu dingin dengan kelompok pasien yang diberikan larutan irigasi bersuhu kamar. Kesimpulan: Larutan irigasi bersuhu dingin berpengaruh terhadap pembengkakan, namun tidak berpengaruh pada rasa nyeri pasca odontektomi. Background: Side effects of mandibular third molar surgery that happen occur are swelling and pain. Many practitioners have used cold therapy to reduce swelling and pain after third molar surgery, but the use of cold irrigation solution by dentist is still rare. Objective: To evaluate the effect of cold irrigation solution on swelling and pain after third molar surgery. Methods:  Prospective study on patients in RSKGM FKG UI with impacted teeth and underwent third molar surgery. Patients were divided into two groups; intervention group with cold irrigation solution and control group with room temperature irrigation solution. Swelling and pain intensity on both groups were measured and compared on operative day, days 3 and 7 post operative. Result: There was significant swelling difference between both group, but there was no significant pain difference between both group. Conclusion: Cold irrigation solution effects swelling after third molar surgery, but doesnt effect the pain."
2019
S-Pdf
UI - Skripsi Membership  Universitas Indonesia Library
cover
Jamieson, Glyn G.
The anatomy of general surgical operations
Edinburgh: Elsevier, Churchill Livingstone, 2009
617 JAM a
Buku Teks SO  Universitas Indonesia Library
cover
Dodi Andrian
Analisis praktik klinik keperawatan kesehatan masyarakat perkotaan pada pasien kolelitiasis di ruang bedah lantai 4 utara RSUP Fatmawati = Analysis clinical practice of urban community health with colelithiasis patients in surgicals room 4th floor north RSUP Fatmawati
"ABSTRAK
Perilaku dan gaya hidup masyarakat perkotaan dalam mengkonsumsi makanan cepat saji yang tinggi lemak dan kolesterol merupakan faktor risiko terjadinya kolelitiasis. Karya ilmiah akhir Ners ini menggambarkan pelaksanaan asuhan keperawatan pada pasien pascabedah kolesistektomi. Peran perawat sangat penting untuk memberikan edukasi tentang diet rendah lemak pada pasien kolelitiasis. Pembatasan asupan kolesterol untuk mencegah terjadinya hipersaturasi cairan empedu yang akan memicu terbentuknya batu empedu kembali setelah pengangkatan kandung empedu. Peningkatan pemahaman pasien tentang diet rendah lemak untuk mengubah perilaku pasien setelah pulang dari rumah sakit. Pengaturan lingkungan dan penggunaan media yang lebih bervariasi dalam edukasi pada pasien.
ABSTRACT
Urban behavior and lifestyle in consumpting fast food which contains high fat and cholesterol was a risk factor for cholelithiasis. This Ners paper described the implementation of nursing care for post cholecystectomy patients. Nurse's role was very important to give education about low-fat dietary for cholelithiasis patient. Cholesterol intake restriction to prevent hipersaturasion of bile which would trigger the formation of new gallstones after gallblader removal. Improvement of patient understanding about the low-fat diet to change the patient behavior after discharge from hospital. Environment settings and more varied use of media in educating the patient."
Depok: Fakultas Ilmu Keperawatan Universitas Indonesia, 2015
PR-pdf
UI - Tugas Akhir  Universitas Indonesia Library
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