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Abstrak :
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.

Abstrak :
ABSTRAK
Nama : Muhammad ZakiProgram Studi : Magister Ilmu KeperawatanJudul : Pengaruh Mobilisasi Dini dan Konsumsi Air Mineral Dua Jam Post Laparoskopik Kolesistektomi Terhadap Penurunan Skala Nyeri Bahu Pasien. Pembedahan laparoskopik kolesistektomi dapat menimbulkan pneumoperitonium yang akan menimbulkan efek nyeri pada bahu pasien yang secara nyata banyak muncul pada jam ke enam setelah pembedahan selesai. Penelitian ini bertujuan mengetahui pengaruh mobilisasi dini dan konsumsi air mineral saat diberikan dua jam post laparoskopik kolesistektomi terhadap penurunan skala nyeri bahu pasien. Desain penelitian ini menggunakan quasy experimental pre ndash; post with control group, metode pengumpulan sampel dilakukan secara purposive sampling. Sampel penelitian terdiri atas 18 orang tiap kelompok intervensi dan kelompok kontrol. Uji statistik menggunakan friedman test dan uji wilcoxon didapatkan hasil pengukuran skala nyeri bahu dengan menggunakan Numeric Rating Scale NRS pada jam ke 2, 6 dan jam ke 24 post laparoskopik kolesistektomi menunjukkan secara statistik dan klinis signifikan dalam menurunkan skala nyeri bahu pasien pada kedua kelompok. Sehingga dapat disimpulkan bahwa terdapat perbedaan signifikan pada kelompok kontrol dibandingkan kelompok intervensi pada pengaruh perubahan skala nyeri bahu responden setelah diberi tindakan mobilisasi dini dan konsumsi air mineral dengan p value= 0, 0001; ?

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ABSTRACT
Name Muhammad ZakiStudy Program Master of Nursing ScienceTitle The effectiveness of early mobilization and mineral water Consumption two hours post laparoscopic cholecystectomy on decreasing shoulder pain. Laparoscopic Cholecystectomy is at risk for pneumoperitoneum that lead patients to feel pain on the shoulder after six hours post surgery. This study aimed to determine the effectiveness of early mobilization and consumption of mineral water two hours post laparoscopic cholecystectomy on decreasing the scale of shoulder pain. This queasy experimental study conducted pre post testing that involved 18 intervention groups and control groups. All subjects were chosen based on purposive sampling method. Data were analyzed by using test Friedman and Wilcoxon. The statistical test using Friedman test and Wilcoxon test showed the measurement of shoulder pain scale by using Numeric Rating Scale NRS at 2, 6 and 24 hours post laparoscopic cholecystectomy showed statistically and clinically significant in decreasing patient shoulder pain scale in both groups. So it can be concluded that there are significant differences in the control group compared to the intervention group on the effect of the change of shoulder pain scale after giving the action of early mobilization and mineral water consumption with p value 0, 0001

Abstrak :
Batu empedu /cholelithiawls' adalah suatu penyakit yang cukup banyak terjadi, di Indonesia dilaporkan ada 268 kasus dalam empat tahun (1991-l994). Dimana kasus ini mcmerlukan operasi. Dengan majunya téknologi alat kedokteran dan ilmu kedokteran serta pengetahuan kesehatan rnasyarakat yang terus berkembang, mcnambah keinginan doktcr untuk mernbcrikan pelayanan pembedahan minimal invasy seiring tuntutan pasien akan tindakan pembedahan yang lebih nyaman. Tindakan bedah dengan tehnik Laparoscopic memberikan pilihan altematif bagi penderita karena tindakan pembedahan dengan can ini hanya diperlukan Iuka opcrasi yang minimal/ kwa. 'rmaakan ms memcrlukan biaya yang besar dan sangat bervariasi, tergautungjenis tindakan yang dilakukan. Pada umumnya nnnah sakit di Indonesia mempunyai masalah mengenai informasi biaya yang disebabkan oleh sistem pembayaran langsung pexjasa pelayanan (pee jbr ser-vice).Biaya pelayanan kesehatan yang bervariasi dan scmakin meningkat dikarenakan belum adanya harga standar berdasarkan unit cost untuk berhagai pelayanan kesehatan yang dibedkan. Pengendalian biaya dari bentukfzejbr service ke Prospective Payment System (PPS) perlu dilakukan. Salah satu bentuk PPS adalah Diagnosis Related Grolgps (DRG’S).DRG’s adalah sistem pembayamn perkelompok pcnyakit tanpa melihat tindakan yang cljberikan atau lamanya perawatan di rumah sakit. Tujuan penelitian ini adalah untuk melihat bagaimana pengelompokan, Clinical Pathway dan cost of treatment Cholelirhiasis dengan Laparoscopic Cholecysreclomy berdasarkan DRG’s di Rumah Sakit Gading Pluit tahun 2007. Penelitian ini merupakan penelitian kuantitatif deskriptif dengan rancangan crossecrional retrospekryf Penelitian dilaksanaknn sejak awal Februari 2008 sampai dengan April 2000 dengan' mcnggunakan data sekunder dari kamar opcrasi dan rekam meaik pasien mwar inap dmgan aiggnosa chozezffhfasfr Salam tahun 2001. Unit cost dihitimg dengan manggunakan Activity Based Costing. Analisa data dilakukan secara univariat untuk melihat distribusi Bekuensi, nilai mean, median, modus, nilai minimum dan nilai maksimurn. Pengelompokan Cfialelilhiasis dengan Lqpmoscopic Cholecyszecrorrrv berdasarkan DRG’s di Rumah Sakit Gading Pluit adalah : Laparoscopic Cholecysteclomy mumi, Laparoscopab Chnlecystectomy dengan Penyerta, Laparoscopxb Cholecystectomy dengan Penyulit dan Laparoscopic Cholecysteciomy dengan Penyerta dan Penyulit Berdasarkan basil penclitian diketahui clinical pathway Cholelfrhiasis dengan Laparoscopic Cholecysteciorny terdiri dari 9 tahapan yaitu : pendaiiaran poliklinik, penegakan diaguosa, Admision , penerimaan pasien, pm-oprasi, Operasi, post operasi, pulang dan Billing. Cost of treatment Cholelithiaais dengan Iaparoscopic ChoIecy.s-rectomy di Rumah Sakit Gading Pluit tahun 2007 adalah sebagai berikut : (1) Biaya Laparoscopic Cholecystectomy Rp.8.222.412.- (2) Biaya Laparoscopic Cholecysrectomy dengan Penyerta Rp.9.309.I64,- (3) Biaya Laparoscopic Cfrolecystectomy dengan Penyulit np.13.4a3_3o3,- (4) Biaya Laparoscopic Qliolecystecrorny aengan Pmyuliz can Penyertzi Rp.17.596.6o5,- Ijengan cost recovery rate rumah sdkit rata-rata nilainya 230%. Dari hasil penelitian terlihat manfaatnya melakukan perhitungan biaya rawat ihap berdasarkan Diagnosis Related Groups sebagai dasar penetapan tarif rawat inap. ......Gall-stone/ cholelithiasis is a commonly occurred disease. In Indonesia, there had been 2687 cases of this disease occurred for the last four years (1991 - 1994) that needed surgeries. The advancement of health instruments, medical knowledge, and continuously growing of health awareness in the society, motivate medical practitioner to give a minimally invasive surgery service, inlining with the patients needs ofa more convenient surgery. The Laparoscopic surgery technique gives adds alternative choice to the patient, as this technique only needs a minimum surgical wound. This technique, however, require a large amount of costs; and it will vary according to the medical measure needed. Generaly, Indonesian Hospitals will have a problem in providing infomration about the service fee, due to the direct fee for service payment system.The absence of standard unit costs for many medical services caused the costs of medical services varied and increasing. Therefore, a change of cost control fiom fee per service to Prospective Payment System (PPS) is needed. One type of PPS is Diagnosis Related Groups (DRG’s) .DRG’s is a payment system per type of disease, without looking at the type of measurement given, or treatment dur°ation in the hospital. The objective of this research is to obtain the classification of Clinical Pathway and treatment cost of Cholelithiasis with Laparoscopic Cholecystectomy using DRG's at Gading Pluit Hospital in 2007. This research is uses quantitative descriptive research with a cross-sectional retrospective method. The research was held from Febnrary - April 2008, by using a secondary data 'fiom one surgery room and inpatients medical records diagnosed with Cholclithiasis in 2007. The unit costs were measured by Activity Based Costing. Univariate data analyses were used to see the iiequent distribution, means, median, modus, minimum and maximum value. The groupings of Cholelithiasis with Laparoscopic Cholecystectomy according to DRG's in Gading Pluit Hospital are: pure laparoscopic Cholecystectomy, Laparoscopic Cholccystectomy with complicating disease, Laparoscopic Cholecystectomy with associated condition and Laparoscopic Cholecystectomy with both complicating disease and associated condition. According to the research, it is concluded that there are 9 steps in Cholelithiasis clinical pathway with laparoscopic Cholecystectomy: polyclinic registration, diagnosis, admission, patient acceptance, pre-surgery, surgery, post surgery, discharge and billing. The Costs of Cholelithiasis treatment with Laparoscopic Cholecystectomy at Gading Pluit Hospital in 2007 are as foIlows:(l) Pune Laparoscopic Cholecystcctomy: Rp.8.222.4l2,-(2) Laparoscopic Cholecystectomy with complicating disease: Rp.9,309,l64,- (3)Laparoscopic Cholecystectomy with associated condition Rp.13.483.303,- (4)Laparoscopic Cholecystectomy with both complicating disease and associated condition :Rp. l'7.596.605,-.cost recovery rate for the hospital is approximately 230%. From the research, we can see the benefit of cost calculation using Diagnosis Related Groups as a way to dctcnnine the hospitalization costs.

Abstrak :
ABSTRAKTeknik laparoskopi kolesistektomi merupakan baku emas untuk penanganan kolelitiasis simptomatik. Angka kejadian rawat inap ulang merupakan representasi dari kualitas perawatan yang diberikan Rumah Sakit. Kejadian rawat inap ulang dapat dipengaruhi oleh berbagai macam faktor, baik faktor fisik, sosial budaya, dan medikal pasien. Tujuan penelitian: Menganalisis faktor-faktor yang berhubungan dengan kejadian rawat inap ulang pada pasien paska laparoskopi kolesistektomi. Penelitian ini menggunakan desain cross-sectional dengan pendekatan retrospektif dan memilih 80 responden dengan tehnik consecutive sampling. Metode pengumpulan data dengan kuesioner dan lembar pengumpulan data. Analisis hasil penelitian menggunakan uji korelasi Spearman dan Coefficient contingency, serta uji komparasi Mann-Whitney. Analisis multivariat menggunakan regresi linier. Hasil penelitian menunjukkan bahwa faktor kejadian rawat inap ulang pasien paska laparoskopi kolesistektomi ditentukan usia, tingkat ekonomi, kepatuhan diet, dan tingkat aktivitas pasien sebesar 54,1%, sedangkan sisanya ditentukan oleh faktor lain. Faktor yang paling dominan berhubungan dengan kejadian rawat inap ulang paska laparoskopi kolesistektomi adalah tingkat aktivitas (β= -0,383).

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ABSTRACT Laparoscopic cholecystectomy is the gold standard for the treatment of symptomatic cholelithiasis. The incidence of readmission is a representation of the quality of care provided by the Hospital. Readmission can be influenced by various factors, both physical, socio-cultural, and medical factors. Objective: To analyze factors associated with readmission patients with laparoscopic cholecystectomy. This study used cross-sectional design with retrospective approach and recruited 80 respondents by consecutive sampling technique. Methods of data collection with questionnaires and data collection sheets. Analysis used Spearman and Contingency coefficient correlation, and Mann-Whitney comparison test. Multivariate analysis used linear regression. The results showed that readmission patients pasca laparoscopic cholecystectomy determined by age, economic level, diet adherence, and activity level amounted to 54.1%, while the rest is determined by other factors. The most dominant factor associated with the incidence of readmission pasca laparoscopic cholecystectomy is the level of activity (β = -0,383).

Abstrak :
[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.

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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.]

Abstrak :
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.

Abstrak :
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.

Abstrak :

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.

 

Abstrak :
PURPOSES: The purpose of this study was to evaluate the influence of comorbidities on the surgical outcomes of early cholecystectomy for acute cholecystitis.

METHODS: Data were retrospectively collected for patients with acute cholecystitis who underwent early cholecystectomy. Patients were separated into three groups based on the cholecystitis severity grade, and the surgical outcomes of early cholecystectomy were analyzed. Patients with mild and moderate cholecystitis were subdivided into a comorbidity group (n = 10) and a non-comorbidity group (n = 83).

RESULTS: There were 57 (55.3%) patients with mild cholecystitis, 36 (35.0%) with moderate cholecystitis, and 10 (9.7%) with severe cholecystitis. The surgical outcomes were significantly worse for patients with severe cholecystitis than for patients with mild or moderate cholecystitis. There were no postoperative deaths after cholecystectomy. There were no significant differences in the complication rate (P = 0.629), conversion rate (P = 0.114), or intraoperative blood loss (P = 0.147) between the comorbidity and non-comorbidity groups.

CONCLUSION: Our findings suggest that early cholecystectomy can be performed safely for patients with mild and moderate cholecystitis even if comorbidities are present. Early cholecystectomy may be an alternative treatment strategy for patients with severe cholecystitis who are candidates for anesthesia and surgery.