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"ABSTRACTPurposeTo compare the time-course change in the postoperative anorectal function between laparoscopic intersphincteric resection (ISR) and low anterior resection (LAR).MethodsThis is a single-institution observational study. We evaluated the time-course change in the anorectal function using functional questionnaires before and at 6, 12, and 24 months after laparoscopic ISR or LAR.ResultsSixty-two patients answered the functional questionnaires (28 in the ISR group and 34 in the LAR group). In the ISR group, the Wexner scores at 6, 12, and 24 months postoperatively were significantly higher than preoperatively. Importantly, the Wexner score at 24 months postoperatively was significantly lower than that at 6 months postoperatively. The low GIFO scores at 6 and 12 months postoperatively tended to be recovered to some extent at 24 months postoperatively. In the LAR group, Wexner score at 6 months postoperatively was significantly higher than that preoperatively. Notably, the Wexner score at 12 months postoperatively was recovered to almost the same as that preoperatively. The GIFO scores at 12 months postoperatively were mostly recovered to the same levels as those preoperatively.ConclusionsLaparoscopic ISR exhibits different time-course changes in the anorectal function from laparoscopic LAR."

"The work describes a new method of sphincter salvage in surgery of rectal cancer. Low tumors of the rectum are traditionally treated with amputation of the rectum. However, this operation is not well-received by patients, since it results in a permanent colostomy. By contrast, intersphincteric resection allows sphincter salvage even in low tumors and is now widely accepted among experts in the field of colorectal surgery. The book will describe the basics (pathology,physiology, radiology) as well as the surgical technique and its different modifications."

"ABSTRAKLatar Belakang : Gangguan fungsi defeksi, yang diketahui sebagai sindrom Low Anterior Resection (LARS) menjadi masalah utama paska pembedahan kanker rektum yang akan berpengaruh pada kualitas hidup. Studi ini bertujuan untuk menngetahu insidens LARS pada pasien paska prosedur preservasi sfingter ani dan faktor- faktor yang mempengaruhi LARS.Metode : Pasien kanker rektum yang menjalani eksisi total mesorektal dan anastomosis colorectal selama periode 2017-2018 berpartisipasi dalam pengisian kuesioner LARS. Parameter klinis yang dianalisis dan untuk perbandingan fisiologi anorektal antara mayor LARS dan no LARS atau minor LARS menggunakan pengukuran biofeedback.Hasil: Studi ini melibatkan 40 pasien, mayor LARS didapatkan pada 42,5% pada pasien yang menjalani low anterior resection (LAR). Radioterapi preoperatif dan level anastomosis berhubungan dengan major LARS dengan odd ratio 0,1 (95% CI : 0,02- 0,49) and 0,07 (95% CI 0,01- 0,39). Dilakukan penghitungan luasan dibawah kurva (AUC) dengan cara receiver operating characteristic (ROC) sebesar 0,77 dan didapatkan titik potong level anastomosis di 5 cm dengan nilai ramal negative 88,23%. Pengukuran biofeedback menunjukkan perbedaan signifikan pada tekanan anal istirahat (resting anal pressure) dan tekanan kontraksi maksimal (maximal squeeze pressure) diperkirakan terjadi gangguan pada fungsi sfingter dan terapi preoperatif berperan untuk terjadinya LARS.Kesimpulan: LARS merupakan masalah signifikan yang diteukan pada hampir sepertiga pasien kanker rektum paska pembedahan. Resiko terkena mayor LARS meningkat dengan adanya terapi preoperatif dan rendahnya level anastomosis.

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ABSTRACTBackground : Defective defecation n function, also known as low anterior resection syndrome (LARS), is common problem after surgical treatment of rectal cancer that has a detrimental effect on quality of life. This study aimed to look for the incidence of LARS in patients whose native rectum could not be kept and determine factors influencing major LARS.Methods : Retal cancer patients who underwent tumor removal with mesorectal excision and colorectal anastomosis during the years 2017-2018 were asked to participate a structured interview using the verified version of the LARS questionnaire. Clinical parameters were analyzed and anorectal physiology was compared between those with major LARS and those without LARS by biofeedback measurement.Results : This study included 40 patients ,major LARS was found at 42,5% in those who underwent low anterior resection , which incidence 22% than other group. Preoperative radiotherapy and level of the anastomosis associated with major LARS at an odd ratio 0,1 (95% CI : 0,02- 0,49) and 0,07 (95% CI 0,01- 0,39). The receiver operating characteristic curve showed an area under the curve of 0,77. The cut-off anastomotic level was at 5 cm, which gave a negative predictive value of 88,23%. Biofeedback measurement showed a significant difference in the resting anal pressure and maximal squeeze pressure, which suggests that dearrangement in sphincteric function and preoperative therapy may contribute to the LARS.Conclusion : LARS is significant problem found in about one third of rectal patients after surgery. Risk of having major LARS increases with preoperative treatment and lower anastomotic level."

"ABSTRACTLow anterior resection syndrome (LARS) commonly develops after an anal sphincter-preserving operation (SPO). The etiology of LARS is not well understood, as the anatomical components and physiological function of normal defecation, which may be damaged during the SPO, are not well established. SPOs may damage components of the anal canal (such as the internal anal sphincter, longitudinal conjoint muscle, or hiatal ligament), either mechanically or via injury to the nerves that supply these organs. The function of the rectum is substantially impaired by resection of the rectum, division of the rectococcygeus muscle, and/or injury of the nervous supply. When the remnant rectum is small and does not function properly, an important functional role may be played by the neorectum, which is usually constructed from the left side of the colon. Hypermotility of the remnant colon may affect the manifestation of urge fecal incontinence. To develop an SPO that minimizes the risk of LARS, the anatomy and physiology of the structures involved in normal defecation need to be understood better. LARS is managed similarly to fecal incontinence. In particular, management should focus on reducing colonic motility when urge fecal incontinence is the dominant symptom."

"ABSTRAKKanker rektum merupakan salah satu penyakit keganasan saluran gastrointestinal yang banyak dialami masyarakat perkotaan. Salah satu tindakan pembedahan yang dapat dilakukan adalah operasi metode ultra low anterior resection. Berdasarkan jurnal terkait, pasien paksa operasi metode ultra low anterior resection memiliki risiko sebesar 10-20% terkena sindrom anterior resection dengan gejala kelemahan sfingter anal sehingga mengakibatkan inkontinensia fekal. Salah satu tindakan yang dapat dilakukan kepada pasien untuk mencegah masalah tersebut adalah dengan latihan kegel. Latihan kegel yang dilakukan secara rutin dapat membantu meningkatkan kontrol anus dan menguatkan sfingter anus. Latihan dilakukan secara bertahap sebanyak 4x10 set dalam sehari. Evaluasi latihan kegel dilakukan menggunakan colok dubur untuk mengevaluasi kekuatan kontraksi anus. Sebelum latihan kegel dilakukan, penanganan manajemen nyeri pada pasien paska operasi harus dilaksanakan dengan baik terlebih dahulu agar toleransi latihan kegel tinggi dan latihan dapat dilakukan segera setelah operasi.

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ABSTRAKRectal cancer is a malignancy of the gastrointestinal tract that is experienced by the urban community. One of the surgery choices is ultra low anterior resection method. Based on the relevant journal, patients were treated with this method have 10-20% higher risk of anterior resection syndrome, which symptoms is weakness of the anal sphincter, resulting in fecal incontinence. One of the interventions that can prevent patients from the fecal incontinence is Kegel exercises. Regular exercises can help improve and strengthen control of the anal sphincter. Exercises done gradually as 4x10 sets in a day. The evaluation of exercises using a rectal tusche to evaluate the strength of anus contraction. Before Kegel exercises is started, handling the management of pain post-surgery must be performed well so that patients have a higher tolerance of Kegel exercises and the exercises can be done soon after surgery.;"

"ABSTRACTPurpose Adenosquamous carcinoma (ASC) of the pancreas is a rare malignancy, associated with a poor prognosis after surgical resection, with reported median survival times (MSTs) ranging from 4.4 to 13.1 months. We conducted this study to investigate the long-term outcomes of patients after the resection for ASC.MethodsBetween 2002 and 2016, a total of 456 patients underwent resection for ASC or adenocarcinoma (AC) of the pancreas. ASC was confirmed in 17 (3.7%) of these patients. We analyzed the clinicopathological characteristics and survival of these 17 patients in comparison with those of patients with AC of the pancreas.ResultsThe operative procedures performed were pancreaticoduodenectomy (n = 6) and distal pancreatectomy (n = 11). Seven (41.2%) of the 17 patients underwent combined organ resection. R0 resection was achieved in 16 (94.1%) patients. The 5-year overall survival (OS) rate and MST were 40.3% and 20.9 months, respectively. A squamous component of ≥ 60% (P = 0.001) and R1 resection (P < 0.001) were significantly associated with poor OS for patients with ASCConclusionThis study revealed longer survival and a higher R0 resection rate after aggressive combined resection in our ASC patients than those in previous studies. Although this was only a small series, our findings suggest that local control with aggressive resection may be an effective treatment protocol for ASC patients."

"ABSTRAKNama : Nicholas TambunanProgram Studi : UrologiJudul : Perbandingan Hasil Luaran antara Pneumoperitoneum TekananRendah dengan Tekanan Standar pada Laparoscopic Living Donor Nephrectomy Saat ini, transplantasi ginjal dilakukan melalui prosedur Laparoscopic Living Donor Nephrectomy LLDN dengan cara memasukkan gas CO2 ke dalam ruang intraperitoneum menggunakan tekanan standar 12-15 mmHg . Namun, dikatakan juga bahwa dengan tekanan rendah 8-10 mmHg dapat berkaitan dengan nyeri pasca operasi dan efek samping yang lebih rendah. Ini merupakan studi perbandingan prospektif yang dilakukan di Departemen Urologi, Rumah Sakit Umum Cipto Mangunkusumo mulai bulan November 2015 sampai Agustus 2016. Seluruh subjek menjalani prosedur LLDN. Pada periode ini, subjek menerima prosedur pneumoperitoneum tekanan rendah. Kelompok ini kemudian dibandingkan secara acak dengan kelompok prosedur pneumoperitoneum tekanan standar yang menjalani prosedur LLDN sebelumnya. Dari 85 subjek yang menjalani LLDN dengan tekanan rendah dan standar masing-masing adalah 41 dan 44. Meskipun tidak ada perbedaan signifikan dari nyeri pasca operasi, efek samping pada tekanan rendah lebih rendah daripada tekanan standar p = 0,033 untuk nyeri epigastrik, p = 0,024 untuk mual, dan p = 0,018 untuk muntah . Namun, durante operasi, 22 subjek dengan tekanan rendah perlu mendapatkan konversi gas menjadi tekanan standar. Berdasarkan analisis, penyebab konversi adalah Indeks Massa Tubuh IMT pasien donor yang tinggi p

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ABSTRACTName Nicholas TambunanStudy Program UrologyTitle Comparison of Outcome between Low Pressure and StandardPressure Pneumoperitoneum in Laparoscopic Living DonorNephrectomy Nowadays, kidney transplantation is done through laparoscopic living donor nephrectomy performed by insufflating CO2 gas into intraperitoneum space using standard pressure 12 15mmHg . However, it is also hypothesized that with lower pressure 8 10 mmHg could be used for laparoscopic living donor nephrectomy related with lower postoperative pain and side effects. This was a prospective comparative study done in Department of Urology, Cipto Mangunkusumo General Hospital from November 2015 to August 2016. All subjects underwent laparoscopic living donor nephrectomy LLDN . In this period, the subjects received a low pressure pneumoperitoneum procedure. This group was later compared randomly to a standard pressure pneumoperitoneum procedure group who underwent previous LLDN procedure. Out of 85, subjects underwent LLDN with low and standard pressure were 41 and 44, respectively. Despite nonsignificant difference of post op pain and duration of operation, the side effect in low pressure was lower than standard p 0.033 for epigastric pain, p 0.024 for nausea, and p 0.018 for vomiting . However, 22 subjects with low pressure need to be converted to standard pressure. Based on stratified analysis, the cause of conversion was higher BMI p"

"Tujuan penelitian ini adalah membandingkan hasil pengobatan adenomiosis dengan reseksi dan pemberian inhibitor aromatase. Kasus adenomiosis dengan infertilitas dikumpulkan selama 3 tahuti (Januari 1999 sampai December 2001) yang ilikonfirmasi dengan USG transvaginal. Kasus dibagi 2 kelompuk, masing-masing kelompok I (dengan reseksi per laparotomi) dan kelompok 2 (mendapat inhibitor aromatase anastrozole). Keduanya dinilai tentang gejala klinik, angka kehamilan. dan angka perkainbuhan pascaoperasi. Selama 3 tahun telah ditangani 1619 kasus infertilitas, di antaranya 66 (4.07%) adenomiosis sebanyak 55 kasus dianalisis, terdiri alas 32 kasus kelompok I dan 23 kasus kelompok 2. Dan 32 kasus yang menjalani reseksi, hasil histopatologik menunjukkan 30 (93.75%) adenomiosis dan 2 (6.25%) mioma uteri. Dalatn kelompok 1, 3 kasus hamil, 2 melahirkan bay! hiditp, I kasus teraklnr dengan abortus pada kehamilan 6 minggu. Sebanyak 25 kasus (78.1%) tidak hamil,4 kasus (12.5%) mengalami perkainbuhan, dan pada 24 kasus (75.35%) gejala-gejala klinis hilang. Sementara itu, 23 kasus kelompok 2, sebanyak 2 (8.6%) hamil, masing-masing 1 lahir hidup dan I abortus. Sebanyak 14 kasus (59.1%) gejala klinik hilang. Selama pengobatan 3 bulan dengan inhibitor aromatase terjadi penunuum ukuran lesi antara 7.31 mm' dan 25.90 mm dengan Cl 95% (p < 0.001). Disimpulkan bahwa pengobatan dengan inhibitor aromatase tidak menyembuhkan lesi, hanya mengurangi ukuran lest adenomiosis. Sebaliknya reseksi dapat menghilangkan lesi walauptin perkainbuhan dapat terjadi (12.5%) sesudah I tahun pascaoperasi. (MedJ Indones 2006; 15:18-23).

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The objective of this study was to observe the results of adenomyosis management with resection and administration of aromatase inhibitor. Cases ofademyosis in infertile women were collected for rhree years (January 1999 to December 2001) and the diagnoses were confirmed using transvaginal USG. Cases were grouped into two groups, i.e. group 1 (undergoing laparotomic resection) and group 2 (receiving treatment with aromatase inhibitor of anastrozole). Both groups were evaluated for changes in clinical symptoms, rate of successful pregnancy, and postoperative recurrency rate. During three years as many as 1619 infertility cases were managed, and among which 66 (4.07%) cases of adenomyosis were diagnosed with transvaginal USG. As many as 55 cases were analyzed, i.e., 32 cases underwent resection and 23 cases received aromatase inhibitor. Of 32 cases of surgical resection, the histopathologica! results showed 30 (93.75%) cases of adenomyosis and 2 (6.25%) cases of uterus myoma. In the group undergoing resection three cases (9.4%) were successfully pregnant, i.e., two cases had live birth, one case ended up with 6-week abortion. Moreover. 25 (78.1%) cases were not pregnant and 4 (12.5%) cases had recurrency, while 24 (75.35%) cases experienced disappearance of symptoms yet not pregnant. On the other hand, of 23 canes in the group receiving aromatase inhibitor 2 (8,6%) cases were able to be pregnant, one case had live birth and another case ended up with abortion, while 14 (59.1%) cases had disappearance of symptoms yet not pregnant. During three months of treatment with aromatase inhibitor, a reduction in the lesion size between 7.3! mm and 25.90 mm' were observed with Cl 95% (p < 0.001). In conclusion, treatment with aromatase inihibitor did not heal lesions, but only reduced the size of adenomyosis lesions. On the other hand, resection could heat lesions, yet recurrency of disease may occur (12.5%) after one postoperative year. (Med J Indones 2006; 15:18-23)."

"ABSTRACTPurposeWe compared three dimensional (3D) and two dimensional (2D) measurements of the solid component to determine radiological criteria for sublobar resection of lung adenocarcinoma ≤ 2 cm in size.MethodsWe included 233 surgical cases. The maximum size of the solid component for 3D measurement was calculated by delineating the solid component on successive axial images and reconstructing the 3D surface model.ResultsThe predictive performance for adenocarcinoma in situ (n = 43) and minimally invasive adenocarcinoma (n = 77) were equivalent to areas under the curve of 0,871 and 0,857 for 2D and 3D measurements (p = 0,229), respectively. A solid component of 5 mm had a prognostic impact on both measurements (≤ 5 mm versus > 5 mm p = 0,003 for 2D and p = 0,002 for 3D, log rank test). Survival rates at 5 years were 94,7 96,9% following lobectomy and sublobar resection among patients with a solid component ≤ 5 mm in size. Sublobar resection resulted in worse survival rates, with declines at 5 years of 15,8% on 2D and 11,5% on 3D measurements, than lobectomy in patients with a solid component > 5 mm in size.ConclusionsA solid component ≤ 5 mm in size is an appropriate criterion for sublobar resection for both measurements. In addition, 2D measurement is justified because of its simple implementation."