Search

Background: The incidence rate of bile duct injury has not been changed for many years for both open or laparoscopic technique. Open cholecystectomy has risen from 0.5% to 1.4% when gallbladder removal is performed laparoscopically. Injuries of the bile duct system after laparoscopic cholecystectomy are more complex than that after an open approach, causing significant morbidity and even death. From initial classification published by Bismuth, there have been many classifications of common bile duct injury. We would reported the 30 days mortality rate following reconstruction after bile duct injury according to type of Bismuth classification. Case Report: 7 cases of common bile duct injury were reported from 2016 until 2018 following cholecystectomy (both open and laparoscopic), all cases were diagnosed as early complication and without intra operative cholangiography performed. The most common bile duct injury was Bismuth type II and IV (2 patients in each type). Reconstruction has been done by hepatico jejunostomy for type III and IV. Choledoco Duodenostomy bypass was done for type I and II. 2 patients with bismuth type IV have long standing cholangitis and cannot survive during 30 days of follow up. 4 others patients could survive with no intra abdominal complication nor other morbidity. Conclusion: Bismuth classification was the simpliest type to described the bile duct injury, Bismuth type IV was associated with the high risk of 30 days mortality rate. Keywords: bismuth classification, bile duct injury, cholecystectomy, mortality

Background Colorectal cancer is the most common gastrointestinal tract cancer, there are many factors which plays an important role on short and long term outcome prior to surgery and adjuvant therapy. For many decades, oncological factor has been state as the main of favorable outcome which could be evaluated by diseases free survival (DFS). Current study already evaluated the immune factor which has an important role on the progression on this colorectal cancer patients. Methods We evaluated the colorectal cancer patients whose has been diagnosed as adenocarsinoma colon and rectal from operative speciments. The blood level of CRP, IL-6, IFN?, CB-8, IG G and IG M will be examined initially before the operative procedure done. All patients were stage III colorectal adeno carcinoma and adjuvant chemotherapy has been administered for six months period. The patients whose could not completed the adjuvant chemotherapy will be excluded from the study. The outcome of this study will be evaluated the 1 year disease free survival based on the abdominal CT Scan and chest x-rays. Results There were 2 groups on this study, adults ( 60 years old). 62 patients were included, 30 adults patients and 32 elderly patients has been evaluated for the immune profiles. We found the signifance difference were on the level of CRP, IL-6,IFN?, CB-8, IG G and IG M (p Conclusions Elderly colorectal cancer patients has better immune profiles and has better 1 year disease free survival. Ethics Approval The study has approved by Ethical Committe of Health Study Faculty of Medicine Sebelas Maret University, Indonesia. Approval number: 21457/BD/2020 Consent All of the patients already have a consent for this study

Background Incarserated hernia was one of the most common procedures in gastrointestinal surgery. According to the latest Hernia Guidelines 2018, emergency hernia surgery has been suggested to used mesh in cases without contamination, whether we did by laparoscopic or open conventional procedures, but there was lack of data and recommendation, which kind of mesh should we used which could reduce the incidence of mesh rejection during emergency hernia surgery. Methods Incarserated hernia cases which have been done open conventional hernia repair procedure (Lichtenstein procedure) were included in this study during Januari-December 2019. The patients were divided into two groups; the first group would use light-weight prolene mesh and the other one using heavy-weight mesh. The outcome that would be evaluated was the incidence of mesh rejection during those procedures after 6 months follow up. The cases with the presence of contamination would be excluded from this study. Results 45 patients were included in this study, 24 patients with light-weight prolene mesh following Lichtenstein procedure and 21 patients using the heavy-weight mesh. During the follow-up, there was no drop out of the patient, and during 5 months follow up, we found 1 case of mesh rejection, 2 months after those procedures using heavy-weight mesh and had been managed by the operative procedure for debridement of the mesh rejection. On the other hand, we found no mesh rejection on light-weight mesh group (p Conclusions Light-weight prolene mesh was associated with a lower incidence of mesh rejection during open emergency hernia surgery.

Background For the last two decades, laparoscopy cholecystectomy has been announced as the gold standard procedure for symptomatic cholelithiasis, and calculous cholecystitis with the main benefits was less post-operative pain and shorter length of stay. In other ways, for some other reasons, especially in our national government insurance, we could not perform those procedures in tertiary hospital as a routine procedure. Methods In this retrospective study, we would evaluate, the length of stay difference between open conventional and laparoscopy cholecystectomy on calculous cholecystitis patients from January until December 2017. The length of stay after these procedures would be recorded. All patients had the same prophylactic antibiotic (2 gram of Cefazolin iv) and 1 gram Paracetamol iv twice daily. The patients who have been done the conversion to open cholecystectomy would be excluded from this study. Results 94 calculous cholecystitis cases were evaluated in this study during 1 year period. 71 cases have been done open conventional cholecystectomy, 23 cases have been performed laparoscopy cholecystectomy. The mean length of stay on the open arm was 1.7 days, and 1.5 days for laparoscopy cholecystectomy. 3 patients on the open conventional arm had biliary pancreatitis and empyema gall bladder, and that case has a longer length of stay (3 days). There was no post-operative complication recorded. Conclusions There was no length of stay difference between open conventional and laparoscopy cholecystectomy on calculous cholecystitis patients.

Background Giving Brusein D or Gemcitabine to pancreatic carcinoma cells will re-infect genes that act as tumor suppressor genes. In Brusein D administration there will be activation of p38-MAPK, caspase 9 and caspase 3 as well as inhibition of NF-kB which will stop the synthesis of pancreatic carcinoma DNA so that the cell will carry out cell degradation by apoptosis. In the administration of Gemcitabine, there will be tumor suppressor gene activation, p38-MAPK, which in turn will trigger cell degradation with the mechanism of apoptosis. Methods PANC-1 pancreatic carcinoma cell cultures were divided into three groups. The first group was in control, the second group was treated with three repetitions of the dose of gemcitabine, the third group was treated with three repetitions of the Brusein D dose, then the number of mutant p53 was calculated in each group. Results Mutant p53 expression levels in cultures of pancreatic carcinoma PANC-1 cells in vitro were the least in the Brusein D treatment 2 ug/ml (B 2), which average 12.7%, then Gemcitabine 2 ug/ml (G 2) ) which is an average of 16.7%, followed by Brusein D 1 ug/ml (B 1) which is an average of 22.0%, then followed by Gemcitabine 1 ug/ml (G 1) which is an average of 22.2%, followed by Brusein D 0.5 ug/ml (B 0.5) which is an average of 28.8%, then followed by Gemcitabine 0.5 ug/ml (G 0.5), which is mean average of 29.0%. And the highest level of mutant p53 expression was control, with an average of 51.3%. Conclusions Brusein D ligand from an ethanolic fraction of Makassar Fruit (Brucea javanica (L.) Merr) has the inhibitory potential for mutant p53 expression so that it can be a candidate for the chemotherapeutic agent in cancer with mutations through the p53 pathway.

Background: Colorectal cancer was the most common cancer found in the GI tract; the two most common clinical emergency presentations were intestinal obstruction and perforation on the tumor site or proximally to the distal tumor. During the COVID-19 pandemic, we must face the new condition; we should modify the clinical outpatients’ schedule, which could address the other problem, that colorectal cancer patients refuse to continue treatment planning and that elective and well-prepared operations will be decreased. Methods: We will report the clinical presentation of our colorectal cancer patients during the last 2 months from March until May 2020. All patients with emergency presentation of colorectal cancer will be included; any comorbidities will be recorded on this study. Patients with emergency colorectal cancer who could not fit for emergency operation will be excluded. Inpatient mortality and postoperative complications will be evaluated. Results: During the 2-month period, we evaluated 26 cases of emergency colorectal cancer patients. Most of the patients came with total intestinal obstruction on the emergency presentation (22 cases); the others (4 cases) came with diffuse peritonitis due to colonic perforation. All patients were reported negative for COVID-19 on rapid test. Exploratory laparotomy was done in this emergency setting; 10 patients had sigmoid colon cancer, 15 patients had rectal cancer, and 6 patients had right colonic cancer. Intestinal perforation was found on rectal cancer patients. Tumor resection and primary anastomosis were done on 18 patients, and the others had stoma diversion. Inpatient mortality reported on 4 patients of perforation cases and had cardiopulmonary complication postoperatively. Conclusion: During the COVID-19 pandemic, emergency presentation of colorectal patients increased, and intestinal perforation was the risk factor of inpatient mortality. Citation Format: Budhi Ida Bagus, Metria Ida Bagus, Setyawati Ida Ayu, Mastini Ida Ayu Kade. Increasing of emergency presentation on colorectal cancer patients during COVID-19 pandemic: A retrospective study on single-center academic hospital [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-080.

Background: Nowadays, surgical resection was still the option for resectable colorectal cancer patients, curative resection associated with better clinical outcome and survival rate. Surgical site infection was one of the most common problem during this procedure, fast tract protocols was announced for several years to enhanced recovery after surgery. In many centre, for some other reasons, intra abdominal drain placement was still needed, according to ERAS protocols, early drain removal was recommended for those cases. Methods: We would evaluated the resectable colorectal cancer cases with advanced stage (stage III and IV) whose already been done resection for the tumor. 30 days follow up was done to evaluated the presense of surgical site infection after surgery, the readmission rate associated with post operative infection would be recorded. Unresectable colorectal cancer cases were excluded. Results: 14 cases of colorectal cancer patients were evaluated on this study. 1 patient was 50 years old. The most common case was rectal cancer (8 patients, 57 %), left sided colon cancer was found in 3 cases. Early drain removal (the 3rd post operative days) was done for those cases. We found superficial surgical site infection on 1 case but was not associated with further readmission and was not associated with other intraabdominal complication. Those surgical site infection could be managed conservatively and was suggested with elderly and emergency operation. Conclusion: fast track protocols for early intraabdominal drain removal was safe and not associated with increased risk of surgical site infection and readmission rate.

Background Fluoroquinolone according to Sanford guide is a recommended antibiotic in cases of perforated appendicitis. Oral Levofloxacin has an almost complete bioavailability (≥99%) absorbed by the body, proportional to the intravenous preparation. The aim of this study was to know the difference of injection fluoroquinolone for 3 days was continued orally 4 days with 7 days injection to wound healing operation of complicated appendicitis. There was lack of recommendation about this combination route antibiotics administration. Methods This study was conducted in Surgery Department, Moewardi General Hospital, Indonesia from June – December 2016. Patients with complicated appendicitis who have performed laparotomy appendectomy, with a total of 16 samples. Sampling was taken using consecutive sampling technique. After the operation was made two groups, the first group was given antibiotic levofloxacin 750 mg by injection for 3 days, then given antibiotic levofloxacin tablets. The second group was given iv levofloxacin for 7 days. Wound medication was performed on the third, fifth, and seventh day, the clustering was done non-randomly. The data were tested with Fisher exact test. Results Fisher exact test results obtained p=1000 (p>0,05) meaning that there is no significant difference between antibiotic fluoroquinolone injection for 3 days continued oral 4 days with injection 7 days on the wound healing. There was only 1 patient on combination route group has poor wound healing. All patients in the intravenous group had good wound healing after discharges from hospital. Conclusions There was no significant difference in the use of fluoroquinolone antibiotic injection for 3 days followed by 4 day oral by 7 day injection of wound healing of complicated appendicitis. Combination route on fluoroquinolone antibiotics could reduce the length of stay with no significant complications.

Introduction: Irinotecan is a second-line chemotherapy for colorectal carcinoma. The most frequent irinotecan toxicity is severe diarrhea and suppression of the immune system (neutropenia). Other side effects include nausea, hyperbilirubinemia, fatigue, emesis, fever, weight loss, alopecia, edema, dyspnoea and thromboembolism. Gastrointestinal related symptoms were the most common side effect following this chemotherapy regiment. Methods: This is a retrospective study which evaluated 10 patients with resectable stage III colorectal adeno carsinoma from January till December 2017, whose given adjuvant chemotherapy with FOLFIRI regiments. Data were taken from medical records during chemotherapy period for six months. Any gastrointestinal related symptoms during this period would be reported as Irrinotecan related side effects, and patients that could not completed the chemotherapy cycle will be excluded. Results: There were 10 patients included in this study, consisting of 6 male and 4 women. Patients age ranged from 32 to 65 years with an average of 51.6 years. Of the total patients, 5 patients had left sided colon adeno carcinoma, 3 patients with rectal carcinoma, 1 patient with sigmoid colon adenocarcinoma, and 1 patient with caecum carcinoma. All of the patients had post-chemotherapy complaints, such as nausea, vomiting, and diarrhea which could be tolerated well conservatively. 2 patients were excluded during this period because the symptoms can not be tolerated well and chemotherapy was interupted. Conclusion: Gastrointestinal related symptoms following FOLFIRI chemotherapy were common, the routine use as chemotherapy regiment should be evaluated later.

A spontaneous hepatic haemorrhage (SHH) is a rare condition that results from a breach in the hepatic parenchyma that occurs without an external cause. It is an acute surgical emergency as it results in intra-abdominal bleeding that, if untreated, will progress to haemorrhagic shock and death. The clinical presentation is often non-specific but emergent, and rapid diagnosis and treatment is required, often involving a number of services including interventional radiology, hepatology and surgery. SHH is a rare event most commonly caused by HCC and hepatic adenoma although there are numerous other causative lesions including all recognized benign and malignant hepatic tumours including metastatic cancer. The mechanism of spontaneous bleeding remains unclear but there is evidence for compromised vascular integrity at least in patients with HCC and the incidence of the condition in patients with connective tissue diseases. A diagnosis of SHH is based on a clinical index of suspicion in patients with a known underlying condition. However, this is not always as straightforward as SHH is a rare complication in patients with connective tissue disease. Spontaneous hepatic haemorrhage is one of acute abdominal emergency case with high morbidity and mortality rate. Emergency operation plays an important role in managing this case.