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"ABSTRAKLatar Belakang : penggunaan trauma skor dapat menentukan penanganan pasien traumadengan cepat dan tepat sehingga menurunkan mortalitas hingga 25%. Tujuan : untukmengetahui perbandingan performa skoring GAP dengan TRISS dalam memprediksimortalitas pasien trauma IGD RSCM Januari-Desember 2013. Desain Penelitian : studicross sectional dengan sampel Rekam Medik pasien trauma IGD RSCM. Hasil penelitian :skor GAP memiliki nilai sensitifitas 80% dan spesitifitas 98,8% Kesimpulan : skorGAP sangat baik untuk prediksi pasien trauma yang hidup tetapi kurang baik untukmenentukan prediksi mortalitas pasien trauma di IGD RSCM

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ABSTRACTTitle: The comparison of performance between GAP and TRISS Scoring in theprediction of mortality of trauma patients in the Emergency Room of RSCM fromJanuary until December 2013Background: The use of trauma scoring can speed up the handling of trauma patientsin order to reduce mortality of patients by up to 25%Objective: to know how the result of the performance between GAP and TRISSscoring in the prediction of mortality of trauma patients.Study design: cross sectional study which the sample was taken from MedicalRecords. of trauma patiens for 1 year. Result: showed that the sensitivity GAP valueof 80% and 99,8% for specificity. Conclution: the GAP is very goog for determiningthe prediction of life but not good enough for the prediction of mortality of traumapatients in emergency room of RSCM."

"Transanal Endorectal Pull-Through (TEPT) dan prosedur Duhamel modifikasi (Martin atau Adang) merupakan teknik operasi penanganan Penyakit Hirschsprung (PH). Penelitian ini bertujuan untuk mengetahui luaran jangka panjang pada pasien PH pasca operasi TEPT dan prosedur Duhamel modifikasi di Rumah Sakit Cipto Mangunkusumo. Luaran jangka panjang yang dievaluasi adalah gejala komplikasi konstipasi, fecal soiling, inkontinensia, dan enterokolitis. Penelitian ini menggunakan rancangan analitik cross sectional. Hasil penelitian menunjukkan angka keberhasilan tanpa gejala komplikasi pasca operasi TEPT lebih tinggi dibanding pasca prosedur Duhamel. Didapatkan angka kejadian yang lebih rendah pada seluruh luaran komplikasi terutama konstipasi pada pasien pasca operasi TEPT dibanding pasca prosedur Duhamel modifikasi. Evaluasi jangka panjang menunjukkan operasi satu tahap TEPT secara umum lebih baik dibanding Duhamel modifikasi.

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Transanal Endorectal Pull-Through (TEPT) and Duhamel procedure (Martin or Adang modification) are surgical technique for Hirschprung Disease. The aim of this study was to evaluate the long-term outcome of TEPT and Duhamel procedure in Cipto Mangunkusumo Hospital. This long-term outcome includes constipation, fecal soiling, incontinensia, and enterocolitis. This study use a cross sectional study design. As a results, success rate without symptoms of postoperative complications on TEPT was higher than Duhamel procedure and incidence of complication, especially constipation, on TEPT was lower than Duhamel procedure. In general, long-term outcome of TEPT is better than Duhamel procedure."

"ABSTRAK Pendahuluan Intussusepsi merupakan kegawatdaruratan yang sering terjadi pada anak di bawah dua tahun dengan salah satu plihan tata laksananya adalah operasi Dalam terapi operatif dapat dilakukan dengan dua jenis operasi yaitu reseksi anastomosis langsung atau pembuatan stoma sementara Studi ini dilakukan untuk mengevaluasi keluaran kedua jenis operasi tersebut berupa lama rawat masa awal asupan oral infeksi daerah operasi dan re operasi Metode Studi retrospektif dengan desain potong lintang berdasarkan kelompok jenis operasi reseksi anastomosis langsung atau pembuatan stoma sementara dilakukan di RSCM melalui penelusuran rekam medis Pengambilan sampel secara consecutive sampling dengan kriteria inklusi usia 0 18 th menjalani operasi reseksi anastomosis langsung ditunda di RSCM sedangkan kriteria ekslusi adalah data tidak lengkap atau tidak dilakukan reseksi Data diolah secara statistik dengan analisis komparatif numerik dengan uji Chi square atau uji T tidak berpasangan bila sebaran data normal bila tidak normal dengan uji Mann Whitney Hasil Terdapat 106 subjek dilakukan operasi dengan 40 subjek menjalani operasi reseksi anastomosis langsung dan 46 subjek dengan pembuatan stoma sementara serta 20 subjek dieklusi karena tidak dilakukan reseksi Lama rawat inap dengan median 11 hari 4 36 hari dengan masa awal asupan oral dengan median tiga hari 1 7 hari durasi gejala dengan median tiga hari ABSTRACT Introduction Intussusception is an emergency that found mostly under two years old which one of the therapy is operative management There are two kinds of operation mostly done which are resection anastomosis and temporary stoma followed by stoma closure This study aims to explain outcome of each techniques operation including length of stay duration to start oral intake surgical site infection and re operation Methods Retrospective study using cross sectional design grouping as resection anastomosis group and temporary stoma group was done at RSCM by reviewing patients rsquo medical records Sample achieved by methods of consecutive sampling with inclusion criterias are ages 0 18 years old underwent surgical resection and anastomosis delayed anastomosis at RSCM hospital while the exclusion criterias are incomplete data or not have surgical resection The data were processed statistically Chi square test or unpaired T test used to analyze comparative numerical variables if data distribution is normal While it rsquo s not normal Mann Whitney test was used Results There were 106 subjects consisted of 40 patients belonged to resection anastomosis group and 46 subjects were temporary stoma group while 20 subjects were exluded Median of overall length of stay was 11 days 4 36 days the median of duration to the first oral intake was 3 days 1 7 days and median of clinical onset was three days"

"Latar Belakang : Angka kejadian reseksi anastomosis pada kasus intususepsimasih sangat tinggi. Hal ini dikarenakan masih seringnya pasien datang terlambatsetelah 72 jam, kurangnya SDM untuk melakukan reduksi non operatif, dankurangnya penunjang seperti USG untuk menegakkan diagnosa. Penting untukmemperhatikan presisi, tehnik dan mempertimbangkan usus yang tersisa dalammelakukan reseksi anastomosis. Hingga saat ini belum ada standar operasi khususyang dapat menjadi panduan bagi para dokter bedah dalam melakukan reseksiakibat intususepsi. Karena itu, peneliti tertarik untuk mencari batas reseksi yangdiperlukan untuk menghasilkan suatu anastomosis end-to-end yang optimal danrendah tingkat kebocorannya. Penelitian akan dilakukan kepada tikus sebagai pilotstudy sebelum dilakukan penelitian lebih lanjut.Tujuan : Mengetahui batas reseksi usus yang optimal dinilai dari kebocorananastomosis berdasarkan grading kolagen pada batas reseksi tersebut.Metode : Penelitian ini merupakan penelitian eksperimental dengan hewan cobatikus putih Sprague Dawley. Tikus putih dilakukan intususepsi denganmenggunakan stylet, dari proksimal ke distal. Setelah 45 menit, intususepsi direduksi.Tikus putih dikelompokkan dalam tiga kelompok sesuai batas reseksianastomosis, yang kemudian batas reseksi ini dilakukan pemeriksaan gradingkolagen. Setelah 5 hari, dilakukan laparotomi untuk menilai kebocorananastomosis.Hasil : Pada perbandingan grading kolagen dengan reseksi usus didapatkangrading terbanyak pada batas 1 adalah grading 2 (57,1 %), pada batas 2 grading 2(71,4 %) ,batas 3 grading 3 (71,4%).Perforasi terbanyak ditemukan pada grading2 sebanyak 5 sampel. Pada perbandingan batas reseksi dengan perforasididapatkan perforasi terbanyak pada batas 1 (85,7 %)Simpulan : Terdapat perbedaaan grading kolagen pada batas reseksi usus dimanabatas kelompok batas 3 memiliki grading kolagen yang lebih baik ( grade 3 dan 4)sehingga kelompok batas 3 lebih direkomendasikan secara histopatologis.Grading kolagen dapat dinilai untuk melihat kemungkinan perforasi hasilanastomosis. Terdapat faktor-faktor lain yang dapat mempengaruhi kejadianperforasi selain grading kolagen.

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Background : There is still high presentation of intussuseption cases with resection and

anastomose, caused of multi factors as : patient delay more than 72 hours, less on

profesional expert to do non operative reduction and less of examination such as ultra

sound to make a diagnose. That is important to take attention with pretition, tehniques

and less of intestine when do the resection. There is still no operative standard about the

boundary of resection cause of intussuseption, thats why the author want to do the

experimental to find the optimal part of resection with minimal leakage. The experimental

will do on rat as a pilot study.

Aim : How to get the optimal part of resection compared with anastomotic leakege based

on collagen grading.

Method : The experimental test using a Sprague Dawley rat. We make a intussuseption

on gut rat using a styleth from proximal to distal. The release do after 45 minutes. The

rats then separated into three boundaries group, and did resection-anastomose with each

gut from groups were performed a histopatologic test to count collagen grading. Leakage

of anastomose were examinated after 5 days

Result : In comparison between collagen grading and the extent of resection

obtained the highest grading in group 1 is grade 2 (57,1%), group 2 is grade 2

(71,4%), group 3 (71,4%). The highest Leakage can be found on grade 2 (5

sample).in comparison the extent of resection and leakage,the highest is group 1

(85,7%).

Summary : There are differences about collagen gradingin the extent of bowel

resection which is the third group of resection has higher collagen grading (3 and

4 ) and then more recommended as histopatologic exam. Collagen grading could

be marked to see possibilities of anastomotic leakage. There is some factors that

affect a leakage besides collagen grading."

"ABSTRAK Latar Belakang : Angka kejadian reseksi anastomosis pada kasus intususepsi masih sangat tinggi. Hal ini dikarenakan masih seringnya pasien datang terlambatsetelah 72 jam, kurangnya SDM untuk melakukan reduksi non operatif, dankurangnya penunjang seperti USG untuk menegakkan diagnosa. Penting untukmemperhatikan presisi, tehnik dan mempertimbangkan usus yang tersisa dalammelakukan reseksi anastomosis. Hingga saat ini belum ada standar operasi khususyang dapat menjadi panduan bagi para dokter bedah dalam melakukan reseksiakibat intususepsi. Karena itu, peneliti tertarik untuk mencari batas reseksi yangdiperlukan untuk menghasilkan suatu anastomosis end-to-end yang optimal danrendah tingkat kebocorannya. Penelitian akan dilakukan kepada tikus sebagai pilotstudy sebelum dilakukan penelitian lebih lanjut. Tujuan : Mengetahui batas reseksi usus yang optimal dinilai dari kebocorananastomosis berdasarkan grading kolagen pada batas reseksi tersebut. Metode : Penelitian ini merupakan penelitian eksperimental dengan hewan cobatikus putih Sprague Dawley. Tikus putih dilakukan intususepsi denganmenggunakan stylet, dari proksimal ke distal. Setelah 45 menit, intususepsi direduksi.Tikus putih dikelompokkan dalam tiga kelompok sesuai batas reseksianastomosis, yang kemudian batas reseksi ini dilakukan pemeriksaan gradingkolagen. Setelah 5 hari, dilakukan laparotomi untuk menilai kebocorananastomosis. Hasil : Pada perbandingan grading kolagen dengan reseksi usus didapatkangrading terbanyak pada batas 1 adalah grading 2 (57,1 %), pada batas 2 grading 2(71,4 %) ,batas 3 grading 3 (71,4%).Perforasi terbanyak ditemukan pada grading 2 sebanyak 5 sampel. Pada perbandingan batas reseksi dengan perforasi didapatkan perforasi terbanyak pada batas 1 (85,7 %)Simpulan : Terdapat perbedaaan grading kolagen pada batas reseksi usus dimana batas kelompok batas 3 memiliki grading kolagen yang lebih baik ( grade 3 dan 4)sehingga kelompok batas 3 lebih direkomendasikan secara histopatologis.Grading kolagen dapat dinilai untuk melihat kemungkinan perforasi hasilanastomosis. Terdapat faktor-faktor lain yang dapat mempengaruhi kejadian perforasi selain grading kolagen. ;Background ABSTRACT There is still high presentation of intussuseption cases with resection andanastomose, caused of multi factors as : patient delay more than 72 hours, less onprofesional expert to do non operative reduction and less of examination such as ultrasound to make a diagnose. That is important to take attention with pretition, tehniquesand less of intestine when do the resection. There is still no operative standard about theboundary of resection cause of intussuseption, thats why the author want to do theexperimental to find the optimal part of resection with minimal leakage. The experimental will do on rat as a pilot study. Aim : How to get the optimal part of resection compared with anastomotic leakege basedon collagen grading. Method : The experimental test using a Sprague Dawley rat. We make a intussuseptionon gut rat using a styleth from proximal to distal. The release do after 45 minutes. Therats then separated into three boundaries group, and did resection-anastomose with eachgut from groups were performed a histopatologic test to count collagen grading. Leakageof anastomose were examinated after 5 days Result : In comparison between collagen grading and the extent of resectionobtained the highest grading in group 1 is grade 2 (57,1%), group 2 is grade 2(71,4%), group 3 (71,4%). The highest Leakage can be found on grade 2 (5sample).in comparison the extent of resection and leakage,the highest is group 1(85,7%). Summary : There are differences about collagen gradingin the extent of bowelresection which is the third group of resection has higher collagen grading (3 and4 ) and then more recommended as histopatologic exam. Collagen grading couldbe marked to see possibilities of anastomotic leakage. There is some factors thataffect a leakage besides collagen grading. ;Background : There is still high presentation of intussuseption cases with resection andanastomose, caused of multi factors as : patient delay more than 72 hours, less onprofesional expert to do non operative reduction and less of examination such as ultrasound to make a diagnose. That is important to take attention with pretition, tehniquesand less of intestine when do the resection. There is still no operative standard about theboundary of resection cause of intussuseption, thats why the author want to do theexperimental to find the optimal part of resection with minimal leakage. The experimental will do on rat as a pilot study. Aim : How to get the optimal part of resection compared with anastomotic leakege basedon collagen grading. Method : The experimental test using a Sprague Dawley rat. We make a intussuseptionon gut rat using a styleth from proximal to distal. The release do after 45 minutes. Therats then separated into three boundaries group, and did resection-anastomose with eachgut from groups were performed a histopatologic test to count collagen grading. Leakageof anastomose were examinated after 5 days Result : In comparison between collagen grading and the extent of resectionobtained the highest grading in group 1 is grade 2 (57,1%), group 2 is grade 2(71,4%), group 3 (71,4%). The highest Leakage can be found on grade 2 (5sample).in comparison the extent of resection and leakage,the highest is group 1(85,7%). Summary : There are differences about collagen gradingin the extent of bowelresection which is the third group of resection has higher collagen grading (3 and4 ) and then more recommended as histopatologic exam. Collagen grading couldbe marked to see possibilities of anastomotic leakage. There is some factors thataffect a leakage besides collagen grading. ;Background : There is still high presentation of intussuseption cases with resection andanastomose, caused of multi factors as : patient delay more than 72 hours, less onprofesional expert to do non operative reduction and less of examination such as ultrasound to make a diagnose. That is important to take attention with pretition, tehniquesand less of intestine when do the resection. There is still no operative standard about theboundary of resection cause of intussuseption, thats why the author want to do theexperimental to find the optimal part of resection with minimal leakage. The experimental will do on rat as a pilot study. Aim : How to get the optimal part of resection compared with anastomotic leakege basedon collagen grading. Method : The experimental test using a Sprague Dawley rat. We make a intussuseptionon gut rat using a styleth from proximal to distal. The release do after 45 minutes. Therats then separated into three boundaries group, and did resection-anastomose with eachgut from groups were performed a histopatologic test to count collagen grading. Leakageof anastomose were examinated after 5 days Result : In comparison between collagen grading and the extent of resectionobtained the highest grading in group 1 is grade 2 (57,1%), group 2 is grade 2(71,4%), group 3 (71,4%). The highest Leakage can be found on grade 2 (5sample).in comparison the extent of resection and leakage,the highest is group 1(85,7%). Summary : There are differences about collagen gradingin the extent of bowelresection which is the third group of resection has higher collagen grading (3 and4 ) and then more recommended as histopatologic exam. Collagen grading couldbe marked to see possibilities of anastomotic leakage. There is some factors thataffect a leakage besides collagen grading. ;Background : There is still high presentation of intussuseption cases with resection andanastomose, caused of multi factors as : patient delay more than 72 hours, less onprofesional expert to do non operative reduction and less of examination such as ultrasound to make a diagnose. That is important to take attention with pretition, tehniquesand less of intestine when do the resection. There is still no operative standard about theboundary of resection cause of intussuseption, thats why the author want to do theexperimental to find the optimal part of resection with minimal leakage. The experimental will do on rat as a pilot study. Aim : How to get the optimal part of resection compared with anastomotic leakege basedon collagen grading. Method : The experimental test using a Sprague Dawley rat. We make a intussuseptionon gut rat using a styleth from proximal to distal. The release do after 45 minutes. Therats then separated into three boundaries group, and did resection-anastomose with eachgut from groups were performed a histopatologic test to count collagen grading. Leakageof anastomose were examinated after 5 days Result : In comparison between collagen grading and the extent of resectionobtained the highest grading in group 1 is grade 2 (57,1%), group 2 is grade 2(71,4%), group 3 (71,4%). The highest Leakage can be found on grade 2 (5sample).in comparison the extent of resection and leakage,the highest is group 1(85,7%). Summary : There are differences about collagen gradingin the extent of bowelresection which is the third group of resection has higher collagen grading (3 and4 ) and then more recommended as histopatologic exam. Collagen grading couldbe marked to see possibilities of anastomotic leakage. There is some factors thataffect a leakage besides collagen grading. "

"Pendahuluan. Kebocoran anastomosis merupakan komplikasi yang berat berhubungan dengan peningkatan morbiditas, dan mempengaruhi lama rawat di rumah sakit. Banyak peneliti yang telah meneliti faktor resiko terjadinya kebocoran usus, diantaranya sepsis, malnutrisi, ketegangan garis anastomosis, gangguan perfusi jaringan, obstruksi distal, dll. Usus adalah organ yang rentan terhadap cedera, cedera pada usus dapat menyebabkan edema, ileus, dan kegagalan mekanisme pertahanan usus. Kondisi ini dapat ditemukan pada gastroshizis, invaginasi, strangulasi, penyakit radang usus dan sirosis. Pemberian cairan berlebih dapat menyebabkan edema, peningkatan tekanan intra abdomen, menurunkan aliran darah mesenterik, berpengaruh terhadap penyembuhan dan meningkatkan kebocoran anastomosis. Studi ini bertujuan untuk mengetahui pengaruh edema terhadap anastomosis usus. Metode. Studi eksperimental pada tikus Sprague–Dawley untuk mengetahui pengaruh edema dan pemberian cairan yang berlebihan terhadap anastomosis usus. Hasil. Tidak terdapat perbedaan antara edema usus dan pemberian cairan berlebihan dengan peningkatan kebocoran anastomosis (p=0,178)  Kesimpulan. Edema usus tidak ada hubungan dengan kebocoran anastomosis.

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Introduction. Anastomotic leak is a severe complication associated with increased morbidity, and affects hospital stay. Many researchers have examined risk factors for intestinal leakage, including sepsis, malnutrition, anastomotic line tension, impaired tissue perfusion, distal obstruction, etc. The intestine is an organ that is prone to injury, injury to the intestine can cause edema, ileus, and failure of the intestinal defense mechanism. This condition can be found in gastroshizis, invagination, strangulation, inflammatory bowel disease and cirrhosis. Excessive fluid can cause edema, increase intra-abdominal pressure, decrease mesenteric blood flow, affect healing and increase anastomotic leakage. This study is to investigate intestinal edema on anastomosis. Method. This is an experimental study using Sprague-Dawley to determine the effect of edema and excessive fluid administration on intestinal anastomosis Results. There was no difference between intestinal edema and excessive fluid administration with increased anastomotic leak (p = 0.178). Conclusion. Intestinal edema is not associated with anastomotic leakage."

"Latar 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.

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Background: 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."

"Komplikasi kebocoran anastomosis dan panjangnya reseksi usus non vital pada kasus intususepsi masih menjadi permasalahan. Tujuan: Mengetahui pengaruh NaCl 0.9 dan papaverin terhadap derajat kolagen serta kejadian komplikasi kebocoran anastomosis usus yang mengalami intususepsi pada model tikus putih. Metode: Dilakukan laparotomi pada 21 tikus Sprague-dawley untuk membuat model intususepsi. Setelah 45 menit, dilakukan relaparotomi dan reduksi manual intususepsi. Tikus dibagi 3 kelompok secara random: kelompok A tanpa perlakuan, kelompok B aplikasi NaCl 0,9 hangat, kelompok C aplikasi papaverin di daerah usus yang mengalami strangulasi. Kemudian dilakukan reseksi dan anastomosis pada zona usus yang votalitasnya meragukan. Setelah hari ke-5 dilakukan laparatomi ulang, dinilai secara subjektif ada tidaknya kebocoran anastomosis, dan diambil sampel untuk dinilai grade kolagennya secara mikroskopik dengan parameter Philips. Hasil: Kadar kolagen tertinggi pada kelompok C dan tidak ada kebocoran anastomosis pada kelompok ini. Lima ekor tikus dengan kolagen terendah pada kelompok A dan B, seluruhnya mengalami perforasi. Tikus dengan kolagen grade 3 dan 4 tidak ada yang mengalami perforasi. Perlakuan aplikasi NaCl 0.9 dan papaverin tidak bermakna secara statistik terhadap kejadian perforasi namun bermakna terhadap kadar kolagen. Kesimpulan: NaCl 0.9% dan papaverin memiliki hubungan dengan tingginya derajat kolagen. Tingginya derajat kolagen berhubungan dengan rendahnya kejadian perforasi anastomosis pada model intususepsi tikus.

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Background: In operative management of intussusception case, the most common complication is anastomosis leakage. Many factors influenced the anastomosis leakage and we concern the collagen factor which important in anastomosis wound healing process. We performed experimental study using topical 0.9 warm saline and papaverine at the released intussusceptum bowel.

Aim: To study the effect of topical saline and papaverin application in collagen grading and anastomosis leakage incident in rats intussusception model.

Methods: laparotomy was performed in 21 Sprague dawley rats to create the intussusception model. After the bowel considered ischemic, destrangulation with retrograde milking technique were performed. Rats were randomly divided in 3 groups A, control group B, saline group and C, papaverine group. We gave topical saline or papaverine at the mesenterium of the released intussusceptum bowel then resected and anastomosed the questionable vitality of bowel. After 5 days, the anastomosis leakage were subjectively assessed. The anastomose segment were sampled for measuring the collagen grading Phillips.

Results: Collagen grade of the group C was the highest among other groups and no anastomosis leakage in this group. There were 5 rats with collagen grade 1 and 2 in group A and B, and all 5 anastomosis site were perforated. There is no statistically relation between saline or papaverine application and the leakage events, but the application were significantly effect the collagen grading.

Conclusion: Findings suggest that saline and papaverine increase the collagen grading and the grading decrease the anastomosis leakage incidents."

"Pendahuluan. Pada usus yang mengalami iskemia, maka tindakan reperfusi akan dapat membuat kerusakan yang lebih besar pada usus dan juga organ lain. Penelitian ini bertujuan untuk mengetahui pengaruh destrangulasi intestinal terhadap organ yang dekat dengan organ yang mengalami iskemia yaitu usus halus, dan pada organ yang letaknya berjauhan yaitu gaster dan paru-paru, dibandingkan dengan subyek yang tidak mengalami destrangulasi sebelum reseksi usus. Metode. Studi eksperimental yang bersifat deskriptif analitik pada 14 ekor tikus Sprague-Dawley jantan. Pada kelompok perlakuan destrangulasi-reseksi DR dilakukan strangulasi dengan meligasi satu loop usus selama 4 jam, kemudian dilakukan destrangulasi dan reseksi segmen usus yang iskemia. Pada kelompok perlakuan reseksi R dilakukan strangulasi usus selama 4 jam, kemudian segmen usus yang iskemia direseksi tanpa melakukan destrangulasi terlebih dahulu. Pada kelompok kontrol dilakukan laparotomi tanpa strangulasi maupun reseksi. Empat jam setelah intervensi kedua, tikus dimatikan, dan dilakukan pengambilan sampel dari usus halus, gaster, dan paru-paru untuk pemeriksaan histomorfologi dan biokimia dengan menggunakan malondialdehyde MDA. Hasil. Pada pemeriksaan histomorfologi dan MDA, terdapat peningkatan kerusakan jaringan serta kadar MDA pada jaringan usus halus, namun perbedaannya tidak bermakna. Pada jaringan gaster dan paru-paru tidak ditemukan peningkatan kelainan histomorfologi maupun MDA. Kesimpulan. Destrangulasi intestinal sebelum dilakukan reseksi menimbulkan peningkatan kerusakan jaringan dan stress oksidatif pada usus yang berada di luar batas strangulasi, namun perbedaan yang didapatkan tidak bermakna secara statistik. Strangulasi terbatas pada satu segmen usus halus tidak selalu menimbulkan cedera iskemia-reperfusi pada organ gaster dan paru-paru.

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Introduction. On the intestinal ischemia events, reperfusion towards the injured intestine can cause further damage to the bowel and other organ as well. This study aims to understand the influence of intestinal destrangulation before bowel resection towards organs that are near and far from the ischemic bowel, compared with subjects without intestinal destrangulation. The studied subject's organ was small bowel outside margin of strangulation, stomach, and lung.

Methods. Fourteen male Sprague-Dawley rats were randomized either to destrangulation-resection DR, resection R, or control group. One bowel loop was ligated for 4 hours. On the DR group the strangulated bowel was released for 5 minutes and then resected. On the R group the strangulated bowel was immediately resected without destrangulation. The control group received sham laparotomy. After four hours the animals were euthanasized and samples were drawn from small bowel, stomach, and lung for histologic analysis and biochemical analysis of malondialdehyde MDA level.

Results. The histologic injury and MDA level on the small bowel tissue is unsignificantly higher on the DR group compared to the R group p>0,05 . There was no significant injury to the stomach and lung tissue, or elevation of MDA level in both groups.

Conclusion. Intestinal destrangulation before resection of the bowel cause more tissue injury and oxidative stress on the bowel outside the limit of strangulation, but the difference is not statistically significant. Limited strangulation of one bowel loop do not always cause ischemia-reperfusion injury to stomach and lung."

"Pendahuluan. Cedera iskemia reperfusi CI/R merupakan fenomena kerusakan selular akibat hipoksia yang terjadi lebih hebat saat restorasi oksigen. Strangulasi usus merupakan kasus bedah tersering yang dapat menimbulkan CI/R pada hati sebagai organ yang langsung mendapatkan aliran darah dari usus. Tindakan destrangulasi dalam mengembalikan perfusi oksigen dan menilai viabilitas usus yang dilakukan intraoperatif dapat menimbulkan CI/R terutama pada kasus dimana kemungkinan besar usus akan dilakukan reseksi. Studi ini bertujuan untuk mengetahui pengaruh destrangulasi usus pada kasus strangulasi usus terhadap hati. Metode. Studi eksperimental pada tikus Sprague ndash;Dawley dengan membandingkan kadar Serum Glutamic Oxaloacetic Transaminase SGOT , Serum Glutamic Pyruvic Transaminase SGPT , malondialdehyde MDA serum dan hati serta histopatologi derajat kerusakan hati pada kelompok perlakuan reseksi usus dengan destrangulasi D dan tanpa destrangulasi TD setelah dilakukan strangulasi usus selama 4 jam. Hasil. Tidak terdapat perbedaan kadar SGOT p=0.234 , SGPT p=0.458 , MDA serum p=0.646 dan MDA hati p=0.237 antara kontrol, kelompok D dan TD. Pada histopatologi derajat kerusakan hati terdapat perbedaan bermakna antara kontrol dengan kedua kelompok perlakuan p=0.006 , namun tidak didapatkan perbedaan bermakna antara kelompok D dan TD p=0.902. Kesimpulan. Tindakan destrangulasi sebelum reseksi pada kasus strangulasi usus tidak menimbulkan perbedaan kadar biomarker stress oksidatif dan derajat kerusakan hati dibandingkan dengan tanpa destrangulasi.

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Introduction. Ischaemia-reperfusion injury IRI is cellular injury due to hypoxia with greater impact when oxygen restored. Intestinal strangulation are often in surgical emergency that cause IRI on liver that directly get blood from intestine. Destrangulation that performed intraoperatively as purposes to restored oxygen and to evaluate viability of intestine tissue, can cause IRI particularly on case with partly of intestine will be resected. This study is to investigate intestinal destrangulation effects on liver following intestinal IRI. Method. This is an experimental study using Sprague-Dawley to compare Aspartate Aminotransferase AST, Alanine Aminotransferase ALT, serum and liver malondialdehyde MDA, and histopathology of degree liver injury between group of resection following destrangulation D and without destrangulation WD after 4 hours strangulation of one loop intestine. Results. There were no significant difference on AST p=0.234, ALT p=0.458, serum MDA p=0.646 and liver MDA p=0.237 between control, D and WD group. Histopathology examination showed significant difference between control and both of treatment group p=0.006, but there was no significant difference between D and WD group p=0.902. Conclusion. Destrangulation before resection on the intestinal strangulation cases doesn rsquo;t cause different of oxidative stress biomarker level and degree of liver injury, compare to intestinal resection without destrangulation."