FAKTOR PROGNOSTIK YANG MEMPENGARUHI TERJADINYA STRIKTUR ANASTOMOSIS PASCA PROSEDUR SOAVE DI RSUP DR. SARDJITO, YOGYAKARTA TAHUN 2005-2011

YENDRI JANUARDI, Dr. dr. Rochadi, SpB, SpBA(K)

2012 | Tesis | S2 Ked.Klinik/MS-PPDS

Latar belakang. Hirschsprung’s disease merupakan kasus pembedahan yang sering dilakukan pada kelompok usia kanak-kanak. Gejala dan dan tanda Hirschsprung’s disease dapat berbeda sesuai usia pasien, muntah bilier, diare, kegagalan pengeluaran mekonium dalam 24 jam pertama, ikterik, sulit menyusui, distensi abdomen. Tatalaksana Hirschsprung’s disease terdiri dari non bedah dan bedah. Metode bedah definitif Hirschsprung’s disease antara lain Swenson, Duhamel, Soave dan Rehbein. Soave merupakan prosedur operasi yang sering dilakukan sebagai tatalaksana definitif Hirschsprung’s disease pada kanak-kanak. Striktur anastomosis merupakan komplikasi yang sering terjadi pada prosedur ini. Pembentukan striktur diduga akibat kurangnya suplai darah, regangan pada anastomosis, teknik pembedahan dan tatalaksana pasca operasi. Metode. Penelitian dilaksanakan dari bulan Januari 2005 sampai Juni 2011 di RS. Dr. Sardjito, Yogyakarta menggunakan metode potong lintang retrospektif. Kriteria inklusi adalah penderita yang didiagnosis Hirschsprung’s disease berdasar anamnesis, pemeriksaan fisik dan radiologis, dan telah menjalani operasi metode ERPT periode Januari 2005 – Juni 2011 yang di rawat di RS. Dr. Sardjito dan bersedia ikutserta. Kriteria eksklusi adalah sudah pernah ditangani di rumah sakit lain, riwayat operasi dengan teknik lain atau rekam medis tidak lengkap dan dianalisis menggunakan Chi-square test. p<0,05 dianggap bermakna secara statistik. Hasil. Letak segmen aganglionik short yang mengakibatkan kelainan striktur anastomosis ada 7 (87,5%) pasien dan ultrashort 1 (12,5%) pasien p=0,0018, konstipasi pra operasi 5 (62,5%) pasien dan tidak konstipasi 3 (37,5%) pasien p=0,016 yang mengalami striktur anastomosis. Simpulan. Jenis kelamin, riwayat evakuasi mekonium, kadar hemoglobin, kadar albumin, usia saat operasi, lama operasi, dan lama rawat inap secara statistik tidak bermakna terhadap terjadinya striktur anastomosis pasca operasi prosedur Soave

Background. Hirschsprung's disease is a frequently performed surgical cases in the age group of childhood. Symptoms and signs of Hirschsprung's disease and may differ according to age of patient, biliary vomiting, diarrhea, failure of meconium expenditure within the first 24 hours, jaundice, difficulty feeding, abdominal distension. Management of Hirschsprung's disease consists of nonsurgical and surgical. Definitive surgical methods Hirschsprung's disease, among others, Swenson, Duhamel, Soave and Rehbein. Soave is a surgical procedure is often performed as the definitive management of Hirschsprung's disease in childhood. Anastomosis stricture is a complication that often occurs in this procedure. Stricture formation may be due to lack of blood supply, the strain on the anastomosis, surgical technique and postoperative management of. Methods. The experiment was conducted from January 2005 to June of 2011 in Dr. Sardjito hospital, Yogyakarta using a retrospective cross-sectional method. Inclusion criteria were patients who were diagnosed with Hirschsprung's disease based on anamnesis, physical examination and radiologic, and had undergone surgery method ERPT period January 2005 - June 2011 are cared for in Dr. Sardjito hospital and willing to participate. Exclusion criteria were already been treated in another hospital, a history of surgery with other techniques or incomplete medical records and analyzed using Chi-square test. p <0.05 was considered statistically significant Results. Location of short aganglionic segment abnormalities resulting anastomosis stricture were 7 (87.5%) patients and ultrashort 1 (12.5%) patients p = 0.0018, preoperative constipation 5 (62.5%) patients and no constipation 3 (37.5%) patients who experienced p = 0.016 anastomosis stricture Conclusion. Sex, history of meconium evacuation, levels of hemoglobin, albumin levels, age at surgery, length of surgery, and prolonged hospitalization were not statistically significant to the occurrence of postoperative anastomotic stricture Soaveprocedure

Kata Kunci : Hirschsprung’s disease, Soave prosedur, striktur anastomosis