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"Latar Belakang. Kejadian PONV (Postoperative Nausea and Vomiting) masih menjadi salah satu gejala paling umum pascaanestesia dan pembedahan, di samping nyeri. Terkadang mual dan muntah lebih menyulitkan terutama pada bedah minor atau pasien rawat jalan, karena dapat memperpanjang lama rawat inap di rumah sakit. Patofisiologi dan farmakologi mual muntah pascaoperasi cukup kompleks.Mual dan muntah telah dikaitkan selama bertahun-tahun dengan penggunaan anestesi umum. Kejadian mual muntah meningkat pada operasi laparoskopi, kejadian meningkat sampai 46% - 75%. Kejadian mual muntah pascalaparoskopi di Instalasi Bedah Pusat (IBP) RSCM bulan November 2019 sebesar 45%. Tujuan dari profilaksis kejadian mual muntah ialah untuk mencegah timbulnya kejadian mual muntah sehingga mengurangi biaya perawatan kesehatan di rumah sakit. Di RSCM sedang digalakkan program KMKB (Kendali Mutu Kendali Biaya), haloperidol memiliki keunggulan dibandingkan dengan deksametason, diantaranya lama kerja yang lebih lama dibanding deksametason sehingga mengurangi kejadian mual muntah pada pasien pada lebih dari 24 jam pascaoperasi dan harga haloperidol yang lebih murah dibandingkan dengan harga deksametason. Oleh karena itu, peneliti ingin mengetahui efektifitas haloperidol 1 mg intravena dengan dan deksametason 5 mg intravena untuk mencegah kejadian mual muntah pada pasien dewasa pascabedah laparoskopi. Metode. Penelitian ini merupakan uji klinis acak tersamar ganda untuk membandingkan keefektivitasan haloperidol 1 mg intravena dengan deksametason 5 mg intravena untuk mencegah kejadian mual muntah pada pasien dewasa pascabedah laparoskopi. 80 subjek dilakukan pendataan angka NRS mual muntah dan kejadian mual muntah pascalaparoskopi. Hasil. Penelitian ini menunjukkan angka kejadian mual terdapat perbedaan bermakna (P<0,05) pada 2-6 jam, 6-12 jam, dan 12-24 jam pascabedah laparoskopi. Untuk angka kejadian muntah pascabedah laparoskopi antara kedua kelompok tidak berbeda bermakna (P>0,05). Angka NRS (Numeric Rating Scale) mual muntah secara statistik tidak ada perbedaan bermakna pada kedua kelompok jam ke-2, jam ke-6, jam ke-12, dan jam ke-24. Simpulan. Pemberian haloperidol 1 mg intravena berbeda secara bermakna dibandingkan pemberian deksametason 5 mg intravena secara stastistik untuk mencegah kejadian mual dan tidak berbeda secara bermakna untuk mencegah kejadian muntah pascabedah pada pasien dewasa pascabedah laparoskopi.

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Background. The incidence of PONV (Postoperative Nausea and Vomiting) is still one of the most common symptoms of post-surgery, in addition to pain. Sometimes nausea and vomiting are more difficult, especially in minor surgery or outpatients, because it can extend the length of stay in hospital. The pathophysiology and pharmacology of post-operative nausea and vomiting are complex. The incidence of nausea and vomiting increases in laparoscopic surgery, the incidence increases to 46% - 75%. The aim of prophylaxis on the occurrence of nausea and vomiting is to reduce the incidence of this event, thereby reducing the cost of health care in hospitals. In RSCM the KMKB program is being promoted, haloperidol has advantages compared to dexamethasone, including a longer work time than dexamethasone, thereby reducing the incidence of nausea and vomiting in patients for more than 24 hours postoperatively and haloperidol prices which are cheaper compared to the price of dexamethasone. Therefore, the researchers wanted to know the effectiveness of intravenous haloperidol 1 mg with dexamethasone and 5 mg intravenously to prevent the occurrence of nausea and vomiting in adult patients after laparoscopic surgery.

Methods. This study was a double blind randomized clinical trial to compare the effectiveness of intravenous haloperidol 1 mg with dexamethasone 5 mg intravenously to prevent the occurrence of nausea and vomiting in adult patients after laparoscopic surgery. 80 subjects were collected NRS data collection and post-laparoscopic nausea vomiting.

Results. This study showed a significant difference in the incidence of nausea (P <0.05) at 2-6 hours, 6-12 hours, and 12-24 hours after laparoscopic surgery. The incidence of vomiting after laparoscopic surgery between the two groups was not significantly different (P> 0.05). Number of NRS (Numeric Rating Scale) nausea vomiting statistically there were no significant differences in the two groups of hours 2, 6 hours, 12 hours, and 24 hours.

Conclusion. The administration of haloperidol 1 mg intravenously is significantly different than dexamethasone 5 mg intravenously to prevent the occurrence of nausea and not significantly different to prevent the incidence of postoperative vomiting in adult patients after laparoscopic surgery."

"Latar Belakang: Laparoskopi nefrektomi merupakan teknik pembedahan pilihan untuk pasien donor ginjal di RSCM karena memiliki beberapa keunggulan dibandingkan laparotomi. Pembedahan akan mengaktivasi respon stress yang mempengaruhi perubahan hemodinamik intraoperatif. Kombinasi anestesi regional epidural dengan anestesi umum dapat mengurangi respon stress intraoperatif. Teknik yang digunakan adalah epidural. Blok Quadratus Lumborum (QL) merupakan blok interfasia efektif sebagai analgesia pasca bedah abdomen. Penelitian ini bertujuan untuk menilai respon stress hemodinamik intraoperatif antara blok QL dan epidural pada pasien laparoskopi nefrektomi. Parameter yang dinilai adalah tekanan arteri rata-rata (MAP), laju nadi, indeks kardiak (CI), dan gula darah. Kebutuhan fentanyl intraoperatif juga turut dinilai. Metode: Penelitian ini adalah uji klinis acak tidak tersamar terhadap pasien donor ginjal yang menjalani laparoskopi nefrektomi di RSCM selama bulan Juni hingga September 2018. Dilakukan randomisasi sebanyak 36 subjek menjadi 2 kelompok. Setelah induksi, kelompok epidural diberikan epidural kontinyu bupivacain 0.25% sebanyak 6 ml/jam dan pada kelompok QL diberikan 20 ml bupivacain 0.25% secara bilateral. Variabel MAP, laju nadi, CI, gula darah dan kebutuhan fentanyl intraoperatif dicatat. Analisis data dilakukan melalui uji bivariat t-test tidak berpasangan, Mann-Whitney serta uji multivariat general linear model. Hasil: Perubahan MAP pada kelompok QL lebih baik secara signifikan dibandingkan dengan epidural. Tidak terdapat perbedaan yang bermakna pada variabel laju nadi, CI, gula darah dan kebutuhan fentanyl intraoperatif. Kesimpulan: Blok QL tidak lebih baik dari epidural dalam menurunkan respon stress intraoperatif pada laparoskopi nefrektomi. Akan tetapi perubahan MAP pada blok QL lebih stabil.

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Background: Laparoscopic nephrectomy is a surgical technique preferred for renal donor in RSCM because of its advantages over laparotomy. Surgery activated stress responses thus affected intraoperative hemodynamics. Regional epidural anesthesia often combined with general anesthesia to reduce stress responses. Quadratus Lumborum (QL) block is an interfacial block and effective as abdominal surgery analgesia. This study was aimed to assess intraoperative hemodynamic stress response between QL and epidural block in laparoscopic nephrectomy patients. Mean arterial pressure (MAP), pulse rate, cardiac index (CI), and blood sugar was collected. Intraoperative fentanyl consumption also noted.

Methods: This was a randomized clinical trial of renal donor patients who underwent laparoscopic nephrectomy at RSCM during June to September 2018. A total of 36 subjects were randomized into 2 groups. After induction of general anesthesia, the epidural group received continuous epidural infusion of 0.25% 6 ml / hour of bupivacaine and QL group received 20 ml of 0.25% bupivacaine. MAP variables, pulse rate, CI, blood sugar and intraoperative fentanyl consumption were recorded in both groups. Data was analyzed with bivariate paired t-test, Mann-Whitney and multivariate general linear model test.

Results: MAP changes in QL group is significantly better than epidural group. There was no difference in heart rate, CI, blood glucose and fentanyl consumption intraoperative between two groups.

Conclusion : QL block compared to epidural did not have better result in reducing intraoperative stress response. However, MAP changes in QL group have better stability than epidural group."

"Latar belakang: Emergence agitation (EA) merupakan gangguan perilaku sementara yang sering terjadi pascaanestesia dengan sevoflurane dan berpotensi membahayakan pasien. Pemberian magnesium sulfat 10 % 20 mg/kg bolus IV selama 15 menit, dilanjutkan 10 mg/kg/jam secara infus kontinyu selama pembedahan diketahui mencegah EA. Penelitian ini bertujuan mengetahui efektivitas magnesium sulfat 10% 20 mg/kg bolus IV selama 10 menit pada 10 menit sebelum anestesia selesai dalam mencegah EA pada anak yang menjalani anestesia dengan sevoflurane. Magnesium sulfat dinilai efektif jika dapat menurunkan kejadian EA.Metode: Penelitian uji klinik acak tersamar ganda pada anak usia 1,5-12 tahun yang menjalani anestesia dengan sevoflurane di RSCM pada bulan September-Oktober 2018. Sebanyak 108 subjek didapatkan dengan metode konsekutif yang dirandomisasi menjadi dua kelompok. Kelompok Magnesium (n=54) mendapat magnesium sulfat 10% 20 mg/kg bolus IV selama 10 menit dengan pompa syringe pada 10 menit sebelum anestesia selesai, sedangkan kontrol (n=54) mendapat NaCl 0,9% 0,2 ml/kg bolus IV selama 10 menit dengan pompa syringe pada 10 menit sebelum anestesia selesai. Kejadian EA, waktu pulih, hipotensi pascaoperasi dicatat. EA dinilai dengan Pediatric Anesthesia Emergence Delirium (PAED). Analisis data menggunakan uji multivariat regresi logistik.Hasil: Kejadian EA pada kelompok magnesium sebesar 25,9% sedangkan kontrol 16,7% (OR = 0,786; IK 95% 0,296-2,091; p=0,63). Waktu pulih memiliki nilai rerata 8,2 + 4,74 menit untuk kelompok magnesium dibandingkan kontrol 10,87 + 6,799 menit (OR = 2,667; IK 95% 0,431-4,903; p=0,02). Pada kedua kelompok, tidak didapatkan kejadian hipotensi.Simpulan: Pemberian magnesium sulfat 10% 20 mg/kg bolus IV selama 10 menit pada 10 menit sebelum anestesia selesai secara statistik tidak efektif mencegah kejadian EA pada anak yang menjalani anestesia dengan sevoflurane.

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Background: Emergence agitation (EA) is a common transient behavioral disturbance after anesthesia with sevoflurane and may cause harm. Magnesium sulphate 10% 20 mg/kg as a slow intravenous bolus over 15 minutes, followed by 10 mg/kg/h as a continous intravenous infusion during surgery can prevent EA. This study evaluated the effectivity of magnesium sulphate 10% 20 mg/kg as a slow intravenous bolus over 10 minutes at 10 minutes before anesthesia ended to prevent the incidence of EA in children undergoing anesthesia with sevoflurane. Magnesium sulphate was considered effective if could reduce the incidence of EA.Method: This was a double-blind randomized clinical trial on children aged 1,5-12 years old underwent anesthesia with sevoflurane in RSCM on September until Oktober 2018. One hundred eight subjects were included using consecutive sampling method and randomized into two groups. Magnesium group (n=54) was given magnesium sulphate 10% 20 mg/kg as a slow intravenous bolus over 10 minutes at 10 minutes before anesthesia ended while control group (n=54) was given NaCl 0,9% 0,2 ml/kg as a slow intravenous bolus over 10 minutes at 10 minutes before anesthesia ended. Incidence of EA, recovery time and postoperative hypotension were observed. Pediatric Anesthesia Emergence Delirium (PAED) scale was used to assess EA. Statistical tests used were logistic regresssion multivariate analysis.Result: Incidence of EA in magnesium group was 25,9% while in control group was 16,7% (OR = 0,786; 95% CI 0,296-2,091; p=0,63). Mean recovery time in magnesium group was 8,2 ± 4,74 minutes and control group was 10,87 ± 6,799 minutes (OR = 2,667; 95% CI 0,431-4,903; p=0,02). Hypotension was not found in both groups.Conclusion: Administration of magnesium sulphate 10% 20 mg/kg as a slow intravenous bolus over 10 minutes at 10 minutes before anesthesia ended was not effective to prevent the incidence of EA in children undergoing anesthesia with sevoflurane."

"Pendahuluan dan tujuan: Pendekatan yang digunakan sebelumnya dari nephrectomy donor laparoskopi di pusat kami adalah transperitoneal. Belakangan ini pendekatan retroperitoneal secara rutin digunakan dalam nefrektomi donor. Namun, tidak ada kesimpulan pasti tentang perbedaan objektif antara kedua pendekatan yang telah dicapai hingga saat ini. Penelitian ini bertujuan untuk membandingkan hasil pembedahan antara pendekatan retroperitoneal dan transperitoneal pada nefrektomi donor.Metode: Penelitian ini merupakan penelitian prospektif observasional single center, yang mencakup total 813 subjek yang menjalani nefrektomi donor di Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo. Perbandingan warm ischemic time 1, time to clip, skin to skin, intraoperative blood loss dan komplikasi dilakukan dengan menggunakan Uji Man Whitney di IBM SPPS Statistik 25.Hasil: Sebanyak 687 subjek yang mendapatkan pendekatan transperitoneal dan 126 subjek dengan pendekatan retroperitoneal. Waktu iskemik hangat 1, waktu untuk klip dan kulit ke kulit, pendekatan retroperitoneal memiliki waktu yang jauh lebih lama. Namun, dalam hal kehilangan darah dan komplikasi, pendekatan retroperitoneal memiliki hasil yang lebih baik dengan rata-rata kehilangan darah adalah 50 cc, dibandingkan dengan transperitoneal 100 cc (p<0,001). Tingkat komplikasi serupa pada pendekatan transperitoneal (31 kasus, 4,6%) dibandingkan retroperitoneal (6 kasus 4,7%) Namun, cedera terkait usus dan kandung kemih hanya ditemukan pada pendekatan transperitoneal yang memerlukan pembedahan lebih lanjut.Kesimpulan: LLDN retroperitoneoscopic memberikan beberapa keuntungan termasuk komplikasi peri operasi yang lebih rendah, mengurangi kemungkinan cedera usus dan kandung kemih, dan mengurangi risiko kehilangan darah intraoperatif

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ntroduction and Objectives: The previous used approach of laparoscopic donor nephrectomy in our center was transperitoneal. In recent time retroperitoneal approach is routinely use in donor nephrectomy. However, there is no definitive conclusion on the objective differences between the two approaches that have been reached to date. This study aims to compare the surgical outcome between retroperitoneal and transperitoneal approach in donor nephrectomy.

Method: This is a prospective observational single center study, which covered a total of 813 subject underwent donor nephrectomy in Cipto Mangunkusumo General Hospital. Comparison of warm ischemic time 1, time to clip, skin to skin, intraoperative blood loss and complication was carried out using Man Whitney Test in IBM SPPS Statistic 25.

Results: A Total of 687 subject that received transperitoneal approach and 126 subject with retroperitoneal approach. The warm ischemic time 1, time to clip and skin to skin, retroperitoneal approach has significantly longer time. However, in term of blood loss and complication, retroperitoneal approach has better result with average blood loss is 50 cc, compare to transperitoneal 100 cc (p< 0.001). Complication rate was similar in transperitoneal approach (31 cases, 4,6%) than retroperitoneal (6 cases 4,7%) However, bowel and bladder related injury were only found in transperitoneal approach which need further surgery.

Conclusion: Retroperitoneoscopic LLDN provides several advantages including lower peri operative complications, reduced possibility of bowel and bladder related injury, and reduced the risk of intraoperative blood loss."

"ABSTRAKLaparoscopic Living Donor Nephrectomy LLDN menjadi prosedur standar donor ginjal hidup di beberapa negara, termasuk Indonesia, khususnya di RSUPN Cipto Mangunkusumo Jakarta. Pada LLDN digunakan drain sebagai alat monitoring pasca operasi. Penelitian Randomized Controlled Trial ini dilaksanakan pada 40 pasien donor ginjal di Rumah Sakit Cipto Mangunkusumo Jakarta yang dibagi ke dalam dua grup; grup tanpa drain dan yang menggunakan drain grup kontrol , untuk membandingkan lama rawatan, skala nyeri, kondisi luka operasi, dan keluhan saluran cerna pasca operasi pada kedua grup. Tidak didapatkan perbedaan pada semua parameter antara LLDN menggunakan drain dan tanpa menggunakan drain.

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ABSTRACTLaparoscopic Living Donor Nephrectomy LLDN has become the standard procedure for living kidney donor in several countries, including Indonesia, especially in Cipto Mangunkusumo General Hospital Jakarta. Drainage tube in LLDN is intended as a tool of postoperative monitoring. This randomized controlled trial was performed in 40 LLDN patients in Cipto Mangunkusumo Hospital Jakarta, divided into two groups without drainage tube and using drainage tube control group , in order to compare postoperative length of stay, pain scale, surgical wound condition and gastrointestinal tract complaints. There were no differences found in all evaluated parameters within the two groups."

"[ABSTRAKLatar 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 jamke-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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ABSTRACTBackground: 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.]"

"Teknik 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 pascalaparoskopi 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 penelitian menggunakan uji korelasi Spearman, Coefficient contingency, dan uji komparasi Mann-Whitney. Analisis multivariat menggunakan regresi linier. Hasil penelitian menunjukkan bahwa faktor kejadian rawat inap ulang pasien pascalaparoskopi 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 pascalaparoskopi kolesistektomi adalah tingkat aktivitas (B = -0,383).

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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 post 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 of research used Spearman, Contingency coefficient correlation, and Mann-Whitney comparison test. Multivariate analysis used linear regression.

The results showed that readmission patients post 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 post laparoscopic cholecystectomy is the level of activity (B = -0,383). "

"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.

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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."