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"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."

"ABSTRACT

Riedels lobe is a normal variant form of right liver lobe rarely found. Here we report a case of 38 years old female with an incidental finding not revealed in physical examination, but then known to have hepatomegaly by gynecological ultrasonography. Diagnosis of Riedels lobe was strengthened by similar results on hepatobiliary ultrasonography, abdominal MRI, and diagnostic laparoscopy. Our patient was discharged and had follow up examination three months later. Knowledge regarding this anomaly is essential to be understood because the finding of accessory liver lobe does not always remain asymptomatic as in our patient, but rather can be related to significant clinical complication."

"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)."

"ABSTRACTPada pasien penyakit ginjal tahap akhir, transplantasi ginjal merupakan pilihan terbaik bagi pasien; akan tetapi, delayed graft function dapat menjadi komplikasi bagi pasien yang dapat berkembang menjadi rejeksi (penolakan) terhadap organ donor, sehingga menggagalkan transplantasi. Tujuan: Mengetahui hubungan antara faktor intraoperatif (warm ischemia time 1, cold ischemia time, warm ischemia time 2, waktu urin keluar, dan kompleksitas pembuluh darah) dan kejadian delayed graft function pada resipien. Metode: Peneliti melakukan studi potong-lintang dengan mengambil 611 data rekam medis pasien dari data rekapitulasi transplantasi ginjal di Departemen Urologi, Rumah Sakit Cipto Mangunkusumo, dari rentang waktu November 2011-September 2018. Peneliti kemudian melakukan analisis bivariat dan multivariat untuk menentukan signifikansi hubungan variabel. Hasil: Dari lima variabel yang diteliti, tidak terdapat satu pun variabel yang memiliki hubungan signifikan (p = 0,996; p = 0,125; p = 0,677; p = 0,332; p = 0,748; secara berurutan) dengan kejadian delayed graft function, dari total 545 pasien yang diteliti. Diskusi: Hubungan variabel yang tidak signifikan dapat dijelaskan oleh jenis donor pada penelitian ini yang sepenuhnya donor hidup, sehingga meminimalkan dampak buruk dari stress iskemik dan reperfusion injury yang disebabkan oleh faktor intraoperatif.

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ABSTRACTFor patients with end-stage renal disease, transplantation is the best option for renal replacement therapy; however, Delayed Graft Function can complicates the transplantation, and even progresses into organ rejection, resulting in a failed transplantation. Objective: The purpose of this study was to determine the association between intraoperative factors (warm ischemia time 1, cold ischemia time, warm ischemia time 2, time of first urine output, and blood vessels complexity) and delayed graft function in transplant recipient. Methods: Researcher used cross-sectional study design by collecting 611 patient data of medical record from data recapitulation of renal transplant by Departemen of Urology, Cipto Mangunkusumo National Referral Hospital, from November 2011-September 2018. Selected patient data were then analyzed using bivariate and multivariate analysis. Results: From five variables in this study, none of them have significant association (p = 0,996; p = 0,125; p = 0,677; p = 0,332; p = 748; respectively) with delayed graft function, from a total of 545 patients. Discussion: The insignificant association of variables may be explained by the type of donor in this study, that is compromised entirely of living donor, which reduce the negative impact of ischemic stress and reperfusion injury caused by the intraoperative factors."

"Latar Belakang. Laparoskopi ginekologi memiliki insidens yang cukup tinggi dalam menyebabkan mual dan muntah paska operasi yaitu sekitar 50% dan belum ada obat-obatan yang terbukti efektif mencegah hal ini. Pemberian anti muntah tunggal disebutkan kurang efektif, sehingga dibutuhkan lebih dari satu macam obat, oleh karena itu dilakukan penelitian ini dengan membandingkan pemberian deksametason, ondansetron, serta deksametason dan ondansetron dalam mencegah mual dan muntah paska laparoskopi ginekologi. Metode. Merupakan penelitian eksperimental dengan rancangan randomized clinical trial (RCT). Subyek penelitian dibagi menjadi 3 kelompok, yaitu deksametason+plasebo, ondansetron+plasebo, dan deksametason+ondansetron yang diberikan 1 jam sebelum induksi. Hasil. Didapatkan 57 wanita yang memenuhi kriteria inklusi dan mengikuti penelitian, menjalani laparoskopi ginekologi. Hasil analisis statistik tidak didapatkan perbedaan bermakna rerata skoring mual dan muntah baik pada 6 jam (p=0,418) maupun 12 jam paska operasi pada ketiga kelompok perlakuan (p=0,588), namun demikian kombinasi deksametason dan ondansetron menghasilkan rerata skoring mual dan muntah yang lebih rendah daripada pemberian deksametason atau ondansetron saja. Kesimpulan. Pemberian deksametason, ondansetron dan kombinasi deksametason + ondansetron tidak menurunkan secara bermakna skoring mual dan muntah paska operasi pada wanita yang menjalani laparoskopi ginekologi.

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Background. Gynecological laparoscopy has a fairly high incidence in causing postoperative nausea and vomiting which is about 50 % and there are no drugs that are proven to prevent this effecetively. A single antiemetic less effective to prevent post operative nausea and vomiting, so it takes more than one drug. This study was conducted to compare the administration of dexamethasone, ondansetron, and dexamethasone plus ondansetron in preventing nausea and vomiting after gynecological laparoscopy.

Methods. This study was an experimental study with randomized clinical trials (RCTs) design. The study subjects were divided into 3 groups, dexamethasone + placebo, ondansetron + placebo and dexamethasone + ondansetron that was given 1 hour before induction.

Results. A total of 57 women who fullfill the inclusion criteria and follow the study, undergoing gynecological laparoscopy. The Statistical analysis found no significant differences in mean scoring both nausea and vomiting at 6 hours (p=0.418) and 12 hours post operative in all three treatment groups (p=0.588), but the combination of dexamethasone and ondansetron can reduce post operative nausea and vomiting mean scoring than dexamethasone or ondansetron alone.

Conclusion. Dexamethasone,ondansetron and dexamethasone + ondansetron combination does not reduce postoperative nausea and vomiting scoring significantly in women undergoing gynecological laparoscopy."

"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 "

"Latar Belakang: Keberhasilan suatu negara untuk berkembang dan menjadi sebuah negara yang maju tidak dapat dilepaskan dari bagaimana suatu negara tersebut mengelola perubahan kependudukannya. Angka Total Fertility Rate Indonesia tidak pernah kurang dari 2,6 anak per wanita dalam rentang tahun 2002-2012, jauh dari target yaitu 2,1 anak per wanita. DKI Jakarta sebagai ibukota negara juga berupaya mencapai target dengan meningkatkan akseptor metode kontrasepsi jangka panjang. Telah terdapat beberapa rumah sakit yang menerima pelatihan oleh Perkumpulan Kontrasepsi Mantap Indonesia (PKMI) serta bantuan alat laparoskopi oklusi tuba oleh Badan Koordinasi Keluarga Berencana Nasional (BKKBN) dengan harapan peningkatan jumlah akseptor. Namun ternyata akseptor metode sterilisasi wanita hanya 0,8 dari total jumlah pengguna kontrasepsi modern. Belum diketahui apa penyebab dan kendala dalam pelayanan laparoskopi di Rumah Sakit di Wilayah DKI Jakarta. Untuk itu diperlukan evaluasi pelayanan metode kontrasepsi jangka panjang khususnya laparoskopi oklusi tuba di DKI Jakarta. Tujuan: Untuk mengevaluasi pelayanan sterilisasi laparoskopi oklusi tuba di rumah sakit wilayah DKI Jakarta. Metode: Penelitian studi Kualitatif pada Rumah Sakit yang telah mendapatkan pelatihan Laparoskopi Oklusi Tuba oleh PKMI di Wilayah DKI Jakarta pada bulan September 2017-Maret 2018. Sebanyak 22 Rumah Sakit dengan pengamatan observasional, pengumpulan data, dan wawancara. Hasil: Dari 22 Rumah Sakit di DKI Jakarta yang diteliti, terdapat 8 Rumah Sakit yang melayani laparoskopi oklusi tuba. Aspek sumber daya manusia serta medikolegal menjadi elemen utama dalam mendukung pelayanan di DKI Jakarta. Rumah sakit yang telah melayani menghadapi kendala dalam hal pembiayaan operasional. Tidak dijaminnya laparoskopi oklusi tuba dalam pembiayaan BPJS Kesehatan dan belum adanya sistem pembiayaan dari Pemerintah Provinsi maupun BKKBN mengakibatkan jumlah pasien yang dilayani berkurang. Pada Rumah Sakit yang belum melayani laparoskopi oklusi tuba, ketiadaan peralatan laparoskopi merupakan faktor penghambat utama. Luaran pelayanan laparoskopi oklusi tuba cukup baik, dilihat dari singkatnya masa perawatan dan tidak adanya komplikasi selama pelayanan berlangsung. Kesimpulan: Masalah utama dalam pelayanan laparoskopi oklusi tuba di DKI Jakarta adalah tidak adanya sistem pembiayaan operasional serta kurangnya sarana dan prasarana terutama peralatan laparoskopi. Perlu ditingkatkan komunikasi serta kerjasama dari Rumah Sakit, Pemerintah Provinsi, BKKBN, dan BPJS Kesehatan untuk mengatasi hambatan dalam operasional pelayanan laparoskopi oklusi tuba.

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Background: The success of a country to grow and become developed country can not be separated from how government manage the population growth. Indonesian Total Fertility Rate has never been less than 2.6 children per woman in the period 2002-2012, far from the target of 2.1 children per woman. DKI Jakarta as the state capital also seeks to achieve the target by increasing the acceptors of long term contraception. There have been several hospitals that received training by Perkumpulan Kontrasepsi Mantap Indonesia (PKMI) as well as allocation of laparoscopic tubal occlusion tools by National Population and Family Planning Board (BKKBN) to increase the number of acceptors. However, women sterilization method acceptor is only 0.8 of the total number of modern contraceptive users. Not yet known what are the causes and obstacles in laparoscopic tubal occlusion services in hospitals in the Region of DKI Jakarta. Therefore, it is necessary to evaluate long term contraception service, especially laparoscopic tubal occlusion in DKI Jakarta.Objective: To evaluate the services of Laparoscopic Tubal Occlusion in hospital at DKI Jakarta.Method: Qualitative research study at hospitals that have received Laparoscopic Tubal Occlusion training by PKMI in DKI Jakarta on September 2017 - March 2018. A total of 24 hospitals with observational observation, data collection, and interview.Result: From 22 hospitals in DKI Jakarta studied, only 8 hospitals serving laparoscopic tubal occlusion. Human resources and medicolegal aspects become the main element in supporting services in DKI Jakarta. Hospitals that have served laparoscopy face obstacles in terms of operational financing. No BPJS coverage for laparoscopic tubal occlusion and the absence of a system of financing from the Provincial Government and BKKBN resulted in reduced number of patients served. In hospitals that have not served laparoscopic tubal occlusion, the absence of laparoscopy equipment is a major constraining factor. The outcome of laparoscopic tube occlusion services is quite good, shown by the short duration of treatment and the absence of complications after the procedure.Conclusion: The main problem in laparoscopic tube occlusion service in DKI Jakarta is the absence of operational financing system and lack of facilities especially laparoscopic equipment. The communication and cooperation of Hospital, Provincial Government, BKKBN and BPJS should be improved to overcome obstacles in services of Laparoscopic Tubal Occlusion. "