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"ABSTRAKNama:Devby UlfandiProgram Studi:Ilmu BedahJudul:Perbandingan Insiden Komplikasi Pascaoperasi Herniorafi dengan Mesh Teknik Lichtenstein dengan Teknik Laparoskopi di RSCMPembimbing:dr. Wifanto S.J, SpB-KBD Latar belakang: Angka komplikasi dan kekambuhan pascaoperasi herniorafi cukup tinggi dan menuntut teknik operasi terbaik. Teknik Lichtenstein merupakan gold standard untuk open herniorafi hernia inguinalis. Saat ini teknik laparoskopi minimal invasive semakin berkembang dan banyak studi menunjukkan hasil lebih baik dibandingkan Lichtenstein. Studi ini bertujuan membuktikan perbedaan insidensi komplikasi pascaoperasi herniorafi dengan mesh teknikLichtenstein dan teknik laparoskopi pada pasien hernia inguinalis di RS dr. Cipto Mangunkusumo dalam 5 tahun 2011-2015 . Metode: Studi ini bersifat potong lintang/cross sectional deskriptif analitik terhadap 62 subjek dewasa yang telah menjalani operasi elektif herniorafi dengan mesh di RS dr. Cipto Mangunkusumo. Dengan stratified random sampling subjek dibagi dua kelompok,Lichtenstein dan laparoskopi, kemudian dilakukan analisis statistik dengan Chi square atau uji Fisher, dan regresi logistik multivariat. Didapatkan hubungan apabila ditemukan nilai p

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ABSTRACTABSTRACT Name Devby UlfandiProgram General SurgeryTitle Comparison of Postoperative Complications Incidence Hernioraphy with Mesh between Lichtenstein Technique and Laparoscopic Technique at RSCMCounsellor Wifanto S.J, MD, Digestive Surgeon Background The complication rate and postoperative recurrence hernioraphywas high enough and demanded for the best surgical technique. Lichtenstein is the gold standard technique for open inguinal hernioraphy. Nowadays, a minimally invasive laparoscopic technique is growing and studies showed better results in laparoscopy than Lichtenstein. This study is aimed to To prove THE difference incidence of postoperative complications hernioraphy with mesh by Lichtenstein techniques and laparoscopic techniques in inguinal hernia patients in dr. Cipto Mangunkusumo hospital within 5 years 2011 2015 . Methods We run a cross sectional descriptive analytic research enrolled of 62 adult subjects who had undergone hernioraphy with mesh in elective surgery in dr. Cipto Mangunkusumo hospital. With stratified random sampling subjects was divided into two groups, Lichtenstein and laparoscopic, then all the data is performed to statistical analyze using Chi square or Fisher test, and a multivariate logistic regression. Significancy was found as the difference met "

"Pendahuluan: Hernia inguinal strangulata merupakan kasus kegawatdaruratan bedah yang sering ditemui dan dapat terjadi translokasi bakteri. Klinis strangulata bisa menjadi faktor risiko terjadinya infeksi daerah operasi (IDO) pascaoperasi. Penggunaan mesh merupakan standar tata laksana untuk operasi hernia inguinal elektif, namun penggunaannya pada operasi hernia inguinal strangulata masih kontroversial karena diduga meningkatkan risiko terjadinya IDO. Tujuan penelitian ini adalah menilai kejadian IDO pasca operasi hernia inguinal strangulata dengan/tanpa penggunaan mesh.Metode: Penelitian ini merupakan tinjauan sistematis yang disusun berdasarkan Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Kriteria inklusi meliputi artikel yang melaporkan keluaran kejadian IDO pada operasi hernia menggunakan mesh (Lichtenstein) dan tanpa mesh (Bassini). Artikel yang digunakan diambil dari basis data Cochrane, MEDLINE, EBSCOhost, Scopus, Proquest, ClinicalTrials.gov, dan ICTRP. Hasil: Pencarian literatur didapatkan 275 studi dengan 5 studi yang memenuhi kriteria. Jumlah total subjek 382 orang, 228 (59,7%) di antaranya menjalani prosedur operasi menggunakan mesh (Lichtenstein). Kejadian IDO pada kelompok yang menggunakan mesh (Lichtenstein) 8,3%, lebih rendah dibandingkan kelompok yang tidak menggunakan mesh (Bassini) 12,9%. Selain itu, kejadian rekurensi juga lebih rendah pada kelompok yang menggunakan mesh (Lichtenstein)dibandingkan kelompok yang tidak menggunakan mesh (Bassini), yaitu 0,4% vs 1,9%. Kesimpulan: Penggunaan mesh (Lichtenstein) merupakan tata laksana yang lebih baik untuk pasien dengan hernia inguinal strangulata tanpa perforasi usus dibandingkan tanpa mesh (Bassini). Penggunaan mesh tidak meningkatkan kejadian IDO dan rekurensi pasca operasi.

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Introduction: Strangulated inguinal hernia is a common surgical emergency case that can cause bacterial translocation. Hernia strangulation is a risk factor for surgical site infection (SSI) following hernia surgery. The use of mesh is the standard treatment for an elective inguinal hernia operation, however, its use in strangulated inguinal hernia is still controversial because it is thought to increase the risk of SSI.

Aim and Goal: The aim of this study is to evaluate the better treatment between repair with mesh and without mesh in patients with strangulated inguinal hernia.

Method: This study is a systematic review written based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The inclusion criteria are articles that report SSI incidence following operation with mesh (Lichtenstein) and without mesh (Bassini). Studies were obtained from Cochrane, MEDLINE, EBSCOhost, Scopus, Proquest, ClinicalTrials.gov, and ICTRP databases.

Result: A total of 275 studies were obtained from literature searching, 5 of which were included in this study. Of the total 382 subjects, 228 subjects (59.7%) underwent repair with mesh (Lichtenstein). The incidence of SSI in operation with mesh (Lichtenstein) was 8.3%, lower compared to those without mesh (Bassini) which was 12.9%. In addition, the incidence of hernia recurrence is also lower in operation with mesh (Lichtenstein) compared to without mesh (Bassini), 0.4% vs 1.9%.

Conclusion: The use of mesh is the better treatment procedure for strangulated inguinal hernia compared to without mesh. It does not increase SSI and hernia recurrence following operation."

"Pendahuluan: Saat penutupan primer tidak dapat dilakukan, defek diafragma hernia diafragma kongenital (HDK) memerlukan penutup prosthesis. Mesh organik-absorbable memungkinkan tumbuhnya jaringan host seiring proses degradasi mesh. Bahan sintetik non-absorbable tidak terdegradasi namun cenderung menyusut sehingga seiring perkembangan anak dapat terjadi rekurensi dan deformitas muskuloskeletal. Peneliti menyusun mesh komposit tiga lapis dari polypropylene-human amniotic membrane (HAM)-oxygenated regenerated cellulose (ORC) sebagai anti-adhesi. Efektifitas mesh ini sebagai alternatif penutup defek diafragma dan bagaimana reaksi histologis host terhadap mesh ini akan dinilai.Metode: dibuat defek hemi-diafragma kiri pada 20 tikus Sprague Dawley (SD) yang dibagi menjadi tiga kelompok perlakuan (KP). Defek diafragma KP-1 ditutup dengan polypropylene mesh, KP-2 dengan tiga lapis HAM, dan KP-3 dengan polypropylene-HAM-ORC. Pada hari ke-7 dan 30, dinilai ada-tidaknya rekurensi, asimetri hemithorax, dilanjutkan pemeriksaan histologis derajat jumlah polymorphonuclear cells (PMN), fibroblas, foreign body giant cells (FBGC), angiogenesis, muskularisasi, dan adhesi. Hasil: Tidak terjadi rekurensi defek diafragma dan asimetri hemithorax pada ketiga KP. Gambaran histologis ketiga KP tidak berbeda bermakna kecuali dalam hal angiogenesis pada kelompok yang menggunakan HAM. Kelompok yang menggunakan bahan anti-adhesi (KP-3) mengalami derajat adhesi teringan. Kesimpulan: mesh komposit tiga lapis dapat digunakan sebagai alternatif penutup defek diafragma SD. Mesh ini tidak menimbulkan reaksi inflamasi dan reaksi benda asing secara berlebihan.

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Introduction: When primary closure is not possible, autologous flap or mesh repair is indicated for congenital diaphragmatic hernia (CDH) repair. Absorbable-organic meshes allow ingrowth of host tissue as they are degraded, creating natural and durable neodiaphragm. Non-absorbable synthetic patches act as strengthening replacement for diaphragm but have propensity to shrink and there is concern as the infant grows, musculoskeletal deformity and recurrence may occur. We investigated a composite mesh consist of polypropylene-human amniotic membrane (HAM)-oxygenated regenerated cellulose (ORC) as adhesion barrier. The aim of the study was to evaluate the effectiviness and host reaction to the implantated mesh.

Methods: a defect on left hemi-diaphragm of 20 Sprague Dawley were made. The first group received polypropylene mesh, second group triple layer of HAM, and the third group received HAM-polypropylene-ORC. After 7 and 30 days, reccurence, hemithorax asymmetry, and histological features of neodiaphragm were evaluated.

Results: There were no patch disruption and asymmetries of hemithorax occurred in all groups. There were no significant differences in polymorphonuclear cells (PMN), foreign body giant cell (FBGC), fibroblast, and muscularization degree. However angiogenesis were better in groups who used HAM material. Adhesions in mildest degree were found at group who used ORC.

Conclusion: Triple layer composite mesh can be used as an alternative for diaphragmatic defect repair. There was no exaggerated inflammation or foreign body reaction"

"ABSTRAKTujuan:Penelitian ini bertujuan untuk menganalisis variabel yang berhubungandengan kondisi intra-operatif dan pasca-operasi selama proses pembelajaran danmelakukan evaluasi hasil dari metode berbasismentor-initiated pada LDN di Rumah Sakit Cipto Mangunkusumo (RSCM), Jakarta, Indonesia.Material dan Metode: Penelitian retrospektif ini menggambarkan pengalaman pada 140 prosedur LDN yang dilakukan di RSCM sejak November 2011 sampai Agustus 2014. Sebanyak 66 kasus LDN pertama, dilakukan oleh seorang ahli bedah laparoskopi sebagai operator utama (mentor) dan secara bersamaan, membimbing operator kedua (trainee). Setelah itu, operasi dilakukan secara bergantian oleh kedua ahli bedah. Dilakukan analisis pada variabel yang berhubungan dengan kondisi intra-operatif dan pasca operasi pada 66 kasus LDN pertama, serta analisa perbandingan antara prosedur operasi yang dikerjakan oleh masing-masing ahli bedah.Hasil: Rerata usia pendonor adalah 32.97 tahun dengan rasio jenis kelamin 6:4 (laki-laki:perempuan). Sebanyak 64% pendonor tidak memiliki hubungan keluarga dengan resipien. Donor ginjal kiri dilakukan pada 82.1% (n=112) prosedur, dan kanan sebanyak 17.9% (n=28). Tidak ada perbedaan signifikan pada waktu operasi (p=0.36), Warm Ischemia Time (WIT) 1 (p=0.66), jumlah perdarahan intra-operatif (p=0.46) antara kedua operator. Hanya satu variable (time to clip) yang ditemukan secara statistik bermakna, p = 0.024. Perbandingan antara grup pertama (1-50 LDN) dan grup terakhir (100-140 LDN) hanya variable WIT 1 dan time to clip; p = 0.029, p = 0.029 yang ditemukan signifikan secara statistik.Kesimpulan: LDN merupakan suatu prosedur yang cukup menjanjikan dan aman untuk meningkatkan jumlah pendonor ginjal. Kesulitan untuk mencapai suatu learning curve menjadi permasalahan utama yang harus dihadapi oleh setiap ahli bedah laparoskopik, terutama karena dampak yang potensial terhadap keberhasilan suatu transplantasi ginjal. Pengalaman yang cukup pada operasi laparoskopi saluran kemih bagian atas sangat diperlukan sebelum melakukan LDN. Pendekatan berbasis mentor-initiated akan membantu peserta latihan untuk mengenali dan melakukan keseluruhan operasi dengan baik tanpa membahayakan patient safety.

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ABSTRACTObjective: variables related to both surgical and postoperative outcome during the learning curve and evaluate the result of mentor-initiated approach of laparoscopic donor nephrectomies at Cipto Mangunkusumo Hospital, Jakarta, Indonesia.Materials and Methods: This retrospective study describes our experiences on 140 laparoscopic nephrectomies in living donors performed in Cipto Mangunkusumo Hospital from November 2011 to August 2014. First sixty-six LDN was performed by one experienced laparoscopic surgeon as the main operator while mentoring the second operator. Afterward the surgery was performed alternately between the two surgeons. Variables related to both the surgical and postoperative outcome during the initial phase and comparisons of the procedures performed by each surgeon were analyzed.Results: Donors’ average age was 32.97 years with male female ratio 6 : 4. About 64% patients were not family related. The left kidney procedures was performed 112 times (82.1%), whereas the right kidney 28 procedures (17.9%). No significant difference in operating time done by both operators (p= 0.36), WIT 1 (p=0.66), and intraoperative blood loss (p=0.46) with only time to clip as single statistically significant variable with p=0.024. Comparison between 1-50 LDN group and the 100-140 LDN group on WIT 1 and time to clip were found statistically significant with p = 0.029, p = 0.029. Conclusion: Laparoscopic donor nephrectomy (LDN) is a fairly safe and a promising procedure to increase the kidney donation pool. A steep learning curve is still the main problem that every surgeon had to deal with, mainly due to the concern of its potential impact on graft survival. Experience in laparoscopic upper urinary tract surgery is recommended to start with LDN. A mentor-initiated approach allows the introduction of this procedure to trainees with good results onthe overall surgery without compromising patient safety."

"Laparoscopic entry : traditional methods, new insights and novel approaches discusses traditional methods of laparoscopic surgery, new devices, laparoscopic entry in difficult patients, robotic assisted surgery access, single port entry, gasless access, transvaginal entry and natural orifice surgery. This book illustrates, through the presentation of techniques, methods, photos, images, drawings and pictures, all the possible methods of laparoscopic entry for endoscopic surgeons, either for laparoscopy or for robotics. Laparoscopic entry : traditional methods, new insights and novel approaches describes problems and criticisms of each method and highlights common and rare complications.Written by experts in the field, this book also includes tips and tricks, which can be tailored to each patient."

"ABSTRAKLaparoskopi donor nefrektomi hidup (LDNH) merupakan prosedur unik karena memengaruhi individu sehat. Dengan laparoskopi, nyeri masih dirasakan oleh pasien meskipun telah banyak berkurang. Studi ini bertujuan mengevaluasi nyeri pascaoperasi LDNH, serta pemulihan, dan faktor-faktor yang memengaruhinya. Penelitian ini adalah studi retrospektif noneksperimental dengan analisis deskriptif. Sampel diambil secara konsekutif di Rumah Sakit Cipto Mangunkusumo (RSCM). Kriteria eksklusi mencakup data tidak lengkap, riwayat nyeri kronik, dan konsumsi analgesik jangka panjang. Parameter yang dinilai meliputi data demografik dan data pascaoperasi. Dari bulan November 2011 hingga November 2015, terkumpul 277 pasien dengan median usia 30 (18-62) tahun dan rasio laki-laki:perempuan 9:4. Nyeri dinilai dengan Visual Analogue Scale (VAS) dan dikelompokkan menjadi nyeri ringan (0-2), sedang (3-4), dan berat (5-10). Didapatkan skor VAS pasca-LDNH hari-1 2(1-6), hari ke-2 2(0-4), dan hari ke-3 1(0-3). Perbaikan skor dari hari ke-1 hingga hari ke-3 signifikan (p<0,001). Nyeri berat hanya ditemukan pada hari ke-1 (2,2%). Metode anestesi yang digunakan, yaitu analgesik epidural (82,3%) dan kombinasi epidural-intravena (17,7%). Durasi analgesik epidural 2(1-7) hari, durasi kateterisasi 7(3-30) hari, durasi rawat inap 3(2-9) hari, kembali ke aktivitas normal 7(3-30) hari, dan kembali bekerja 14(6-90) hari. Terdapat hubungan yang signifikan antara VAS hari 1 dan 3 dengan relasi donor-resipien (p<0,001 dan p=0,029). VAS lebih tinggi ditemukan pada donor yang memiliki relasi dengan resipien. Kesimpulan penelitian ini adalah penanganan nyeri dan pemulihan pasien pasca-LDNH di RSCM sudah baik, dibuktikan dengan rendahnya skor VAS pascaoperasi dan baiknya parameter pascaoperasi. Nilai VAS berkorelasi dengan donor yang memiliki relasi, tetapi hal ini perlu diteliti lebih lanjut.

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ABSTRACTLaparoscopic living donor nephrectomy (LLDN) is a unique procedure as it can give impact to a healthy individual. Although postoperative pain in donor nephrectomy has been far reduced by laparoscopic technique, patients still can experience considerable pain. The aim of this study was to evaluate the LLDN postoperative pain and patients recovery as well as related factors. This study was non-experimental using descriptive analytic method with retrospective study design. Data of patients who underwent consecutive LLDN in Cipto Mangunkusumo Hospital were collected. Exclusion criteria were patients with incomplete data, history of chronic pain and long-term analgesic consumption. The parameters evaluated were demographic data (age, sex, body mass index, donor site, related or unrelated donor) and postoperative data (postoperative pain, types of analgesia, duration of catheterization, hospital length of stay, return to normal activities and return to work). Statistical analysis was carried out using SPSS version 20.0 with p-value less than 0.05 was considered statistically significant. From November 2011 to November 2015, there were 277 patients included with median age of 30 (18-62) years old and male-to-female ratio 9:4. LLDN postoperative pain was evaluated using Visual Analogue Scale (VAS) and classified to mild (0-2), moderate (3-4) and severe (5-10) pain. The VAS scores on day 1 were 2 (1-6), 2 (0-4) on the day 2, and 1 (0-3) on day 3 post LLDN. This value improved statistically significant from day 1 to day 3 (p<0.001). Severe pain was only found on the first day (2.2%). The most common analgesia technique used was epidural analgesia (82.3%), followed by combination of epidural and intravenous analgesia (17.7%). The postoperative data evaluated were duration of epidural analgesia (2 (1-7) days), duration of urethral catheterization (2 (1-5) days), length of hospital stay (3 (2-9) days), return to normal activities (7 (3-30) days), and return to work (14 (6-90) days). There were no significant relations between VAS scores in the day 1 and 3 with demographic and postoperative data (p>0.05), except in VAS for day 1 and 3 with donor-recipient relation (p<0.001 and p = 0.029); higher VAS was found in kidney donors who were related rather than the unrelated ones. The postoperative pain of LLDN patients in Cipto Mangunkusumo Hospital is adequately managed by analgesia provided as shown by the low postoperative VAS scores. The recovery parameters for LLDN patients also show promising result based on short length of hospital stay, return to normal activities and return to work. Higher VAS score correlated with kidney donors who are related but further studies are still needed to support this finding."

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Nyeri akut adalah salah satu masalah keperawatan yang sering muncul pada klien post laparoskopi kolesistektomi dan berdampak pada aktivitas sehari-hari klien. Nyeri akut pada klien dapat diatasi dengan manajemen nyeri farmakologi dan non-farmakologi. Karya ilmiah akhir ini bertujuan untuk menganalisis manajemen nyeri teknik relaksasi pada klien kolelitiasis post laparoskopi kolesistektomi. Data pengkajian dianalisis dan didapatkan masalah keperawatan utama pada klien yaitu nyeri akut. Penulis melakukan analisis terhadap 8 literature review untuk menyusun asuhan keperawatan pada klien post laparoskopi kolesistektomi. Hasil analisis didapatkan bahwa manajemen nyeri farmakologi dengan pemberian ketorolak  dapat membantu mengurangi nyeri post laparoskopi kolesistektomi. Sedangkan manajemen nyeri non-farmakologi teknik relaksasi efektif untuk mengurangi nyeri pada klien post laparoskopi kolesistektomi. Edukasi teknik relaksasi pada klien merupakan salah satu peran perawat, agar manfaat teknik relaksasi untuk mengurangi nyeri post laparoskopi kolesistektomi dapat dirasakan oleh klien

 

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Acute pain is one of the nursing problems that often arises in post-laparoscopic cholecystectomy clients and impacts on clients daily activities. Acute pain in the client can be overcome by pharmacological and non-pharmacological pain management. This final scientific work aims to analyze the pain management of relaxation techniques in post-laparoscopic cholecystectomy clients. The assessment data were analyzed and the main nursing problem for the client was acute Pain. The author conducted an analysis of 8 literature reviews related to compile nursing care in post-laparoscopic cholecystectomy clients. The results of the analysis found that pharmacological pain management by giving ketorolac can help reduce post-laparoscopic cholecystectomy pain. Whereas non-pharmacological pain management relaxation techniques are effective for reducing pain in post laparoscopic cholecystectomy clients. Relaxation education on clients is one of the roles of nurses, so that the benefits of relaxation techniques to reduce post laparoscopic cholecystectomy pain can be felt by the client.

 

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"Nyeri punggung bawah merupakan salah satu keluhan yang paling sering ditemukan di masyarakat. Hernia Nukleus Pulposus (HNP) adalah penyebab nyeri punggung bawah terbanyak yang dapat mengganggu aktivitas sehari-hari dan gangguan tidur pada penderitanya, sehingga menjadi masalah kesehatan utama dan memerlukan tindak lanjut yang serius. Dalam memberikan asuhan keperawatan yang berkualitas dan profesional, diperlukan landasan teori untuk mengatasi masalah keperawatan sesuai dengan kondisi pasien. Teori adaptasi Roy dipilih karena pada teori ini perawat didorong untuk mempromosikan adaptasi yang diharapkan dapat dicapai pasien selama masa perawatannya. Metode yang kami gunakan adalah studi kasus, pada pasien laki-laki berusia 62 tahun dengan HNP Thoracal 12, Lumbal 1,2,3. Pasien mengalami nyeri punggung sampai tungkai bawah, dan memiliki riwayat post operasi laminektomi dekompresi atas indikasi HNP Thoracal 8-11 dua tahun sebelumnya. Pada perawatan ini pasien menjalani operasi stabilisasi posterior. Hasil implementasi keperawatan pada masalah utama nyeri, pasien adaptif dengan rasa nyeri dengan mampu melakukan teknik distraksi nyeri dan melaporkan skala nyeri ringan (1-2) saat pulang. Pada masalah mobilitas, pasien adaptif terhadap keseimbangan dengan mampu berjalan menggunakan alat bantu tongkat setelah 5 hari post operasi. Pasien tidak mengalami komplikasi selama perawatan. Pasien adaptif pada masalah obesitas dengan mampu kontrol diri terhadap gangguan makan untuk menurunkan berat badan dan terjadi peningkatan performa peran dengan kondisi sakitnya. Kesimpulan yang didapat adalah bahwa pendekatan model adaptasi Roy berguna dalam kasus ini karena berfokus pada kemampuan beradaptasi pasien dan sesuai untuk digunakan dalam manajemen keperawatan perioperatif pada Hernia Nukleus Pulposus.

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Low back pain is one of the most common complaints in society. Hernia Nucleus Pulposus (HNP) is the most common cause of low back pain which can interfere with daily activities and disrupt sleep in sufferers, so that it becomes a major health problem and requires serious follow-up. In providing quality and professional nursing care, a theoretical basis is needed to address nursing problems according to the patient's condition. Roy's adaptation theory was chosen because in this theory nurses are encouraged to promote adaptations that are expected to be achieved by patients during their treatment period. The method we use is a case study, in a 62 year old male patient with HNP Thoracal 12, Lumbar 1,2,3. The patient experienced back pain down to the lower limbs, and had a postoperative history of decompressive laminectomy for indications of HNP Thoracal 8-11 two years previously. In this treatment the patient underwent posterior stabilization surgery. The results of the implementation of nursing on the main problem of pain, patients are adaptive to pain by being able to perform pain distraction techniques and report a mild pain scale (1-2) when they go home. In terms of mobility problems, the patient is adaptive to balance by being able to walk using a cane after 5 days post surgery. The patient had no complications during treatment. Patients adaptive to the problem of obesity by being able to control themselves against eating disorders to lose weight and there is an increase in role performance with their illness. The conclusion obtained is that Roy's adaptation model approach is useful in this case because it focuses on patient adaptability and is suitable for use in perioperative nursing management of Hernia Nucleus Pulposus."