PERBANDINGAN PENGARUH JAHITAN CONTINUOUS SMALL STITCH DAN SIMPLE SMALL STITCH DENGAN BENANG POLYGLYCOLIDE TERHADAP EKSPRESI TRANSFORMING GROWTH FACTOR BETA PADA GARIS INSISI FASIA ABDOMEN TIKUS GALUR WISTAR (Rattus norvegicus)

DION NUR ANGGORO, dr. Imam Sofii, Sp.B-KBD.; Prof. dr. Marijata, Sp.B-KBD

2019 | Tesis-Spesialis | ILMU BEDAH

Latar Belakang: Laparotomi insisi median merupakan tindakan operasi yang paling sering dilakukan dalam setiap tindakan operasi bedah digesti. Komplikasi yang sering terjadi adalah hernia insisional. Fibroblas pada fasia mensekresi transforming growth factor beta. Transforming growth factor beta berperan penting dalam penyembuhan luka. Teknik jahitan merupakan salah satu faktor yang mempengaruhi terjadinya hernia insisional. Tujuan: Untuk membandingkan pengaruh continuous small stitch dan simple small stitch pada penutupan fasia abdomen. Metode: Dua puluh tikus digunakan pada dua kelompok. Kelompok continuous small stitch dimana jahitan ditempatkan 5 mm dari tepi fasia secara kontinyu dan kelompok simple small stitch ditempatkan 5 mm dari tepi fasia secara satu-satu. Luka insisi fasia ditutup dengan jahitan menggunakan benang polyglycolide. Tikus didekapitasi pada hari ke 4 dan 7. Potongan jaringan diperiksa ekspresi TGF-Beta dengan imunohistokimia. Perbedaan rerata kelompok dianalisis dengan uji t. Hasil: Tikus pada kelompok continuous small stitch memiliki ekspresi TGF-Beta yang lebih tinggi pada hari ke 4 dan 7 dibandingkan pada kelompok simple small stitch (45 [SD 10] vs 29 [9], p = 0,029; 67 [SD 7] vs 21 [ 2], p = 0.009). Kesimpulan: Kelompok continuous mall stitch mempunyai ekspresi TGF-Beta yang lebih tinggi daripada kelompok simple small stitch dan bermakna signifikan secara statistik.

Background: Midline laparotomy is the common incision in every digest surgery. Incisional hernia is a frequent complication of midline laparotomy. The fibroblast of the fasia, secretes transforming growth factor beta. Transforming growth factor beta has crucial roles in the wound healing process. The suture technique is important determinant of the risk of developing an incisional hernia. Aim: To compare the continuous small stitch technique with the simple small stitch technique for abdominal fasial closure. Methods: Twenty rats were used in two groups. The continuous small stitch group received small tissue bites of 5 mm continuing and the simple small stitch group received small tissue bites of 5 mm one by one. The incisions of fasia were closed by suture using polyglycolide. Animals were euthanized on days 4 and 7. Histological sections of the tissue-embedded sutures were subjected to TGF-Beta expression. The differences were analyzed with t tests. Results: Rats in the continuous small stitch group had higher TGF-Beta expression on days 4 and 7 than those in the simple small stitch group (45 [SD 10] vs 29 [9], p=0.029; 67 [SD 7] vs 21 [2], p=0.009). Conclusion: The continuous small stitch group achieve higher TGF-Beta expressions than the simple small stitch group and significant statistically.

Kata Kunci : polyglycolide, continuous small stitch, simple small stitch, TGF-Beta, penutupan fasia abdomen, polyglycolide, continuous small stitch, simple small stitch, TGF-Beta, abdominal fascial closure.