PERBANDINGAN PENGARUH INTERVAL JAHITAN KONTINYU LARGE STITCH DAN SMALL STITCH DENGAN BENANG POLYVINYLIDENE FLUORIDE TERHADAP EKSPRESI INTERLEUKIN-6 PADA GARIS INSISI FASIA ABDOMEN TIKUS ALBINO GALUR WISTAR (Rattus norvegicus)

HERYU PRIMA, dr. Imam Sofii, Sp.B-KBD.; Dr. dr. Ishandono Dachlan, M.Sc, Sp.B, Sp.BP-RE(K)

2019 | Tesis-Spesialis | ILMU BEDAH

Latar Belakang: Hernia insisional merupakan komplikasi laparotomi median yang sering terjadi. Disrupsi fasia menyebabkan hernia insisional. Fibroblas pada fasia, mensekresi IL-6. Interleukin-6 memiliki peran penting dalam proses penyembuhan luka. Teknik jahitan adalah salah faktor risiko penting dalam kejadian hernia insisional. Tujuan: Membandingkan pengaruh large stitch dan small stitch pada penutupan fasia abdomen. Metode: Dua puluh tikus digunakan pada dua kelompok. Kelompok small stitch dimana jahitan ditempatkan 5 mm dari tepi fasia dan kelompok large stitch ditempatkan 10 mm dari tepi fasia. Luka insisi fasia ditutup dengan jahitan kontinyu menggunakan polyvinylidene fluorida. Tikus didekapitasi pada hari keempat dan ketujuh. Potongan jaringan diperiksa ekspresi IL-6 dengan imunohistokimia. Perbedaan rerata kelompok dianalisis dengan uji t. Hasil: Tikus pada kelompok small stitch memiliki ekspresi IL-6 yang lebih tinggi pada hari ke-4 dan ke-7 dibandingkan pada kelompok large stitch (38,4 [SD 25,91] vs 37,13 [22,75], p = 0,834, Cohens d = 0,07; 69,67 [SD 43,97] vs 58,33 [35,02], p = 0,664, Cohens d = 0,28). Ekspresi IL-6 pada kelompok small stitch adalah 1,29 kali lipat lebih besar pada hari ke-7 dibanding hari ke-4 dan 1,42 kali lebih besar pada kelompok large stitch (p = 0,806, Cohens d = 0,17). Kesimpulan: Kelompok small stitch mempunyai ekspresi IL-6 yang lebih tinggi daripada kelompok large stitch namun tidak signifikan secara statistik.

Background: Incisional hernia is a frequent complication of midline laparotomy. Incisional hernia is the late complication of fasial disruption. The fibroblast of the fasia, secretes IL-6. Interleukin-6 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 large stitch technique with the small stitch technique for abdominal fascial closure. Methods: Twenty rats were used in two groups. The small stitch group received small tissue bites of 5 mm and the large stitch group received large bites of 10 mm. The incisions of fascia were closed by running suture using polyvinylidene fluoride. Animals were euthanized on days 4 and 7. Histological sections of the tissue-embedded sutures were subjected to IL-6 expression. The differences were analyzed with t tests. Results: Rats in the small stitch group had higher IL-6 expression on days 4 and 7 than those in the large stitch group (38,4 [SD 25,91] vs 37,13 [22,75], p = 0,834, Cohens d = 0,07; 69,67 [SD 43,97] vs 58,33 [35,02], p = 0,664, Cohens d = 0,28). Interleukin-6 expressions in the small stitch group were 1,29-fold greater on day 7 than day 4 and were 1,42-fold greater in the large stitch group (p = 0,806, Cohens d = 0,17). Conclusion: The small stitch group achieve higher interleukin-6 expressions than the large stitch group but not significant statistically.

Kata Kunci : polyvinylidene fluoride, large stitch, small stitch, interleukin-6, penutupan fasia abdomen, polyvinylidene fluoride, large stitch, small stitch, interleukin-6, abdominal fasial closure