Perbandingan Derajat Adhesi dan Nilai Makrofag pada Penguatan Penutupan Defek Hernia Insisional dengan Free Omental Patch dan Mesh Composite pada Tikus Albino Galur Wistar (Rattus norvegicus)

Joshua Andrew, Dr. dr. Imam Sofii, Sp.B, Subsp.B.D(K); Prof. Dr. dr. Irianiwati, Sp.PA., Subsp.O.G.P.(K)

2026 | Tesis-Spesialis | S2 Ilmu Bedah

Latar belakang: Hernia insisional adalah komplikasi operasi pada insisi dinding abdomen berupa protrusi organ internal melalui lokus minoris luka bekas operasi yang tidak sembuh. Mesh composite (MC) merupakan terapi standar baku emas untuk hernia insisional, namun ketersediaanya masih terbatas di Indonesia. Free omental patch (FOP) sebagai potensi alternatif biologis namun belum banyak diteliti. Makrofag merupakan salah satu mediator inflamasi yang paling berperan pada penyembuhan luka dan adhesi merupakan salah satu komplikasi operasi hernia insisional.

Tujuan: Penelitian ini bertujuan untuk mengetahui perbedaan derajat adhesi dan nilai makrofag pada penguatan penutupan defek dinding abdomen dengan FOP dan MC.

Metode: Penelitian eksperimental murni ini dilakukan dengan desain posttest only control pada 12 tikus Wistar jantan yang dibagi menjadi dua kelompok, yaitu FOP dan kelompok MC. Hernia insisional diinduksi pada hewan coba dan dilakukan koreksi dan penguatan area defek dengan bahan uji. Setelah 4 minggu dari perlakuan, seluruh hewan coba dikorbankan dan dilakukan evaluasi derajat adhesi secara makroskopis dan analisis jumlah makrofag melalui pemeriksaan histopatologi dengan pewarnaan Hematoksilin-Eosin pada 5 lapang pandang, kemudian dihitung reratanya. Analisis statistik menggunakan uji ANOVA dan Mann-Whitney dengan tingkat signifikansi p<0>

Hasil: Pada kelompok FOP, 4 subjek tidak mengalami adhesi (derajat 0), 2 subjek mengalami adhesi derajat 2, sedangkan pada kelompok MC, 2 subjek mengalami adhesi derajat 1, 2 subjek mengalami adhesi derajat 2, dan 2 subjek mengalami adhesi derajat 3 (p=0.046*). Rerata nilai makrofag 5 lapang pandang pada kelompok free omental patch 34,125, sedangkan kelompok mesh composite 36,000 (p=0.697).

Kesimpulan: Adhesi lebih banyak ditemui pada kelompok MC dibandingkan dengan FOP. Tidak ada perbedaan pada nilai makrofag pada penguatan hernia menggunakan MC dengan FOP.

Background: An incisional hernia is a postoperative complication characterized by the protrusion of internal organs through a defect, in an incompletely healed abdominal wall incision. While composite mesh (CM) is currently the gold standard treatment for incisional hernia repair, its availability remains limited in Indonesia. The free omental patch (FOP) presents a potential biological alternative; however, it has not yet been extensively investigated. Furthermore, macrophages act as crucial inflammatory mediators in the wound healing process, and adhesion formation remains a significant complication associated with incisional hernia surgery.

Objectives: This study aims to determine the differences in adhesion severity and macrophage counts following the reinforcement of abdominal wall defects with FOP versus CM.

Methods: This true experimental study utilized a posttest-only control group design involving 12 male Wistar rats, which were divided into two groups: the FOP group and the CM (composite mesh) group. Incisional hernias were induced in the animal models, followed by the surgical repair and reinforcement of the defect area using the respective test materials. Four weeks post-intervention, all animals were euthanized. A macroscopic evaluation of adhesion severity was performed, alongside a quantitative analysis of macrophages via histopathological examination. Macrophage counts were assessed using Hematoxylin and Eosin (H&E) staining across five high-power fields, from which the mean values were subsequently calculated. Statistical analysis was conducted utilizing ANOVA and Mann-Whitney U tests, with statistical significance defined as p < 0>

Results: In the FOP group, four subjects exhibited no adhesions (grade 0) and two subjects developed grade 2 adhesions. Conversely, in the CM group, two subjects presented with grade 1 adhesions, two subjects with grade 2 adhesions, and two subjects with grade 3 adhesions (p = 0.046*). Furthermore, the mean macrophage count across five visual fields was 34.125 in the free omental patch group, compared to 36.000 in the composite mesh group (p = 0.697).

Conclusion: A higher incidence of adhesion formation was observed in the CM group compared to the FOP group; however, there was no significant difference in macrophage counts between the two methods of hernia reinforcement in rat model.

Kata Kunci : Adhesi, free omental patch, hernia insisional, makrofag, mesh composite, rattus novergicus