Perbandingan Luaran Fungsional Jangka Panjang pada Pasien Hirschsprung Pasca Soave dan TEPT di RSUP Dr. Sardjito Yogyakarta

Theodora Monica Carissa, dr. Gunadi, Ph.D., Sp. BA ; dr. Andi Dwihantoro, Sp.B, Sp.BA (K)

2019 | Skripsi | S1 KEDOKTERAN

Latar belakang: Penyakit Hirschsprung (HSCR) adalah penyakit kongenital dengan tidak adanya sel ganglion intramural pada pleksus mienterikus dan pleksus submukosal pada hindgut. Insidensi HSCR di Indonesia 1:3.250 kelahiran hidup. Penanganan HSCR dilakukan dengan berbagai metode pembedahan dimana 2 metode yang dapat digunakan adalah Soave dan TEPT (Transanal Endorectal Pull-Through). Data mengenai perbandingan hasil luaran fungsional jangka panjang pasca Soave dan TEPT belum banyak didapatkan terutama di Indonesia. Tujuan: Mengetahui luaran fungsional jangka panjang (follow-up lebih dari sama dengan 3 tahun) pasien HSCR pasca Soave, pasien HSCR pasca TEPT dan perbandingan luaran fungsional jangka panjang pasien HSCR pasca Soave dan TEPT di RSUP Dr. Sardjito Yogyakarta. Metode: Penelitian menggunakan desain penelitian kohort retrospektif dan kohort prospektif. Data diperoleh melalui rekam medis dengan periode 1 Januari 2012 hingga 31 Desember 2015 dan hasil wawancara via telepon menggunakan kuesioner Rintala. Hasil luaran fungsional jangka panjang pasca operasi Soave dan TEPT akan dianalisis secara deskriptif dengan berdasar penilaian Rintala. Hasil: Wawancara dilakukan pada 21 subjek dimana 8 subjek pasca Soave dan 13 subjek pasca TEPT. Luaran fungsional kemampuan defekasi, soiling, dan inkontinensia ekal pada subjek pasca Soave lebih baik dengan OR 0,96, 0,63 dan 0,29 secara berurutan. Namun, luaran fungsional rasa ingin defekasi, frekuensi defekasi, konstipasi dan masalah sosial lebih baik pada subjek pasca TEPT dengan OR 2, 3,3, 17,18 dan 1,71 secara berurutan. Konstipasi merupakan luaran fungsional yang mendekati hasil bermakna (p-value=0,07). Berdasarkan interpretasi penilaian Rintala yaitu buruk, cukup, baik dan sangat baik, jumlah subjek pasca Soave berdasarkan interpretasi tersebut adalah 2 orang, 3 orang, 2 orang dan 1 orang secara berurutan. Sementara pada subjek pasca TEPT 1 orang, 4 orang, 6 orang, dan 2 orang secara berurutan. Kesimpulan: Dominasi luaran fungsional jangka panjang pasien HSCR pasca Soave menurut skor Rintala adalah cukup dan dominasi luaran fungsional jangka panjang pasien HSCR pasca TEPT adalah baik. Bila dibandingkan subjek pasca Soave lebih berisiko mendapatkan interpretasi buruk 4 kali daripada subjek pasca TEPT. Namun semua hasil didapatkan dengan p-value >0,05.

Background: Hirschsprung's disease (HSCR) is a congenital disease characterized by the absence of intramural ganglion cells in the myenteric plexus and submukosal plexus of hindgut. Incidence of HSCR in Indonesia 1: 3,250 live births. HSCR patients can be treated by various surgical methods where 2 methods that can be used are Soave and TEPT (Transanal Endorectal Pull-Through). Surgery with different methods can give different outcomes. Comparison data of the results of long-term functional outcomes after Soave and TEPT have not been widely obtained, especially in Indonesia. Objectives: To find out the long-term functional outcomes (follow-up is more than or equal to 3 years) of HSCR patients after Soave, HSCR patients after TEPT and comparison of long-term functional outcomes of HSCR patients after Soave and TEPT in Central Hospital of Dr.Sardjito Yogyakarta. Method: The study used a retrospective and prospective cohort study design. Data obtained through medical records with the period January 1, 2012 to December 31, 2015 and results of interviews via telephone using the Rintala questionnaire. Long-term functional outcomes after the Soave and TEPT operations will be analyzed descriptively based on the Rintala score. Results: Interviews were conducted on 21 subjects where 8 subjects were post-Soave and 13 subjects were post-TEPT. The functional outcomes of ability to hold back defecation, soiling, and accidents in post-Soave subjects are better than TEPT's with OR 0.96, 0.63 and 0.29 respectively. However, the functional outcomes of feels/reports urge to defecate, frequency of defecation, constipation and social problems are better in the post-TEPT subjects than Soave's with OR 2, 3.3, 17.18 and 1.71 respectively. Constipation is a functional outcome that approaches significant results (p-value = 0.07). Based on the interpretation of the Rintala score which is classified into poor, fair, good and excellent, the number of post-Soave subjects based on these interpretations is 2 people, 3 people, 2 people and 1 person respectively. While for post-TEPT subjects 1 person, 4 people, 6 people, and 2 people respectively. Conclusions: The dominance of long-term functional outcomes of HSCR patients post-Soave according to Rintala score is fair and the dominance of long-term functional outcomes of HSCR patients post-TEPT is good. When compared to post-Soave subjects, it is more risky to get poor interpretation 4 times than the post-TEPT subjects. But all results are obtained with p-value> 0.05.

Kata Kunci : Hirschsprung, Soave, TEPT, luaran fungsional, jangka panjang, penilaian Rintala.