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All Journal Medical Journal of Indonesia The New Ropanasuri Journal of Surgery
Toar J.M. Lalisang
Digestive Surgery Division, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology

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Pancreaticoduodenectomy for periampullary tumors at Dr. Cipto Mangunkusumo Hospital, Jakarta Lalisang, Toar J.M.; Simanjuntak, Arnold; Philippi, Bennardus
Medical Journal of Indonesia Vol 13, No 3 (2004): July-September
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (158.41 KB) | DOI: 10.13181/mji.v13i3.143

Abstract

We reported our experience on 31 pancreaticoduodenectomy out of 141 periampullary tumors during 1994 until 2002; 16 of them were female, and age average 17-68 years. Jaundice was the most common presenting sign; 14 patients showed plasma albumin lower than 3.5 g/dl, and 10 patients had bilirubin level more than 10 mg/dl. We performed classical Whipple technique in 17, pyloric preserving pancreaticoduodenectomy in 11, and total pancreaticoduodenectomy in 3 patients. The mean of operative time was 436 minutes (290-570 minutes). The patients were grouped into 2 periods, between 1994-1999 and thereafter. With experience, the amount of blood loss has decreased from 2000 ml to 400 ml. Histopathologic results showed adenocarcinoma of the pancreas head in 11, adenocarcinoma of the ampulla of Vater in 11, carcinoma of duodenum in 4, head of pancreas benign cyst in 2, and benign tumor in 3 patients. The surgical mortality was 4 in the first 12 patients, in contrast to only 1 in the last 19 patients. The most serious complication was pancreatic leakage in 14 patients, in 4 of them it was responsible as the cause of death. The length of stay after operation varied between 12 and 47 days. Until the end of this report 7 patients are still alive, and 4 patients lost of contact. Recurrence was detected in 13 out of 22 survivors, occurring between 4 to 24 months after operation and 12 patients died 2-3 months later. Three patients died due to other causes. We conclude that pancreoticoduodenectomy is an effective technique, and the operative mortality is decreasing. Furthermore, morbidity especially from pancreatic leakages can be treated in our hospital. (Med J Indones 2004; 13: 166-70) Keywords: operative outcome, Whipple technique, pancreatic leakage
Pre operative radiation for icteric type hepatocellular carcinoma A case report Nugroho, Adianto; Lalisang, Toar J.M.; Gondhowiarjo, Soehartati
Medical Journal of Indonesia Vol 17, No 4 (2008): October-December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (593.515 KB) | DOI: 10.13181/mji.v17i4.326

Abstract

Hepatocellular Carcinoma (HCC) is still a leading health problem worldwide, due to its correlation with HBV and HCV infection and its management which is strongly dependent on patient’s condition and tumor extension. Surgery, with liver resection or liver transplantation offer a good survival rate as a primary management of such cancer. But since liver resection must consider some aspect of liver function and tumor size, and liver transplantation was not a choice in Indonesia, many treatment modalities has been developed which can be used to overcome this problem, such as tumor ablation, transarterial chemo embolization (TACE), chemotherapy and radiotherapy. With the development of conformal radiotherapy, the hepatitis induced radiation therapy could be minimized. This paper present a case of conformal radiation therapy utilization in icteric type HCC in Dr. Cipto Mangunkusumo Hospital, Jakarta. Hepatic resection was planned for this patient. (Med J Indones 2008; 17: 255-8)Keywords: Hepatocellular Carcinoma, icteric type, radiation therapy, conformal radiotherapy
Comparison of the efficacy and safety of isepamicin plus metronidazole and amikacin plus metronidazole in intra-abdominal infections Philippi, Bernardus; Lalisang, Toar J.M.; Th-Akib, Husniah; Setiabudy, Rianto; Hudiono, Johannes; Darmansjah, Iwan
Medical Journal of Indonesia Vol 10, No 2 (2001): April-June
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (763.04 KB) | DOI: 10.13181/mji.v10i2.11

Abstract

Intra-abdominal infections due to penetrating wound through the abdominal wall or rupture of the gastrointestinal tract are acute conditions requiring prompt surgical intervention and the use of appropriate antimicrobial agents. Isepamicin is an effective aminoglycoside against various Gram-negative pathogens causing intra-abdominal infections. The objective of the present study is to compare the efficacy and safety of isepamicin (15 mg/kgBW IV o.d.) with amikacin (7.5 mg/kgBB b.i.d.), in conjunction with metronidazole for both drugs. An open, randomized, parallel design was applied in this trial. The subject allocation ratio for isepamicin: amikacin is 2:1. Out of 50 patients enrolled in this study, 27 fuffilled the criteria for safety and efficacy population, and 46 for intent-to-treat population. In the safety and efficacy population, the clinical success rare for isepamicin and amikacin group did not differ significantly (i.e., 95% and 100%, respectively). In the intent-to-treat population, the clinical success rates for isepamicin and amikacin group were also insignifficantly different (i.e., 97% and 100%, respectively). The rates of bacteriological elimination for isepamicin and amikacin, were 95% and 100%, respectively in the efficacy and safety population, and 90% and 93%, respectively in the intent-to-treat population. Streptococci and staphylococci were the most frequent (40%) pathogens isolated from pus, and Acinetobacter anitratus (55%) was the most common one isolated from blood. In the efficacy and safety population, the mean (± SD) length of hospital stay in the isepamicin and amikacin groups was 10.7 ± 3.9 and 11.1 ± 3.8 days, respectively, while in the intent-to-treat population, the mean (± SD) length of hospital stay in the isepamicin and amikacin groups was 10.1 ± 3.4 and 10.5 ± 3 days, respectively. In the present study, both aminoglycosides were well tolerated and there was no patient withdrawal associated with side effect. It is concluded that for intra-abdominal infections, intravenous isepamicin given once daily is as effective as intravenous amikacin given twice daily in combination with metronidazole. (Med J Indones 2001; 10: 88-94)Keywords : Isepamicin, amikacin, inta-abdominal infections
Validation of simplified predictive score for postoperative mortality after pancreaticoduodenectomy Nugroho, Adianto; Lalisang, Toar J.M.
Medical Journal of Indonesia Vol 23, No 2 (2014): May
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (512.026 KB) | DOI: 10.13181/mji.v23i2.667

Abstract

Background: Pancreaticoduodenectomy has long been associated with high rates of morbidity and mortality. The key to a better postoperative outcome is a good patient selection. The aim of this study was to develop a simplified preoperative predictive score for postoperative mortality after pancreaticoduodenectomy.Methods: Patients who underwent elective pancreaticoduodenectomy from 1995 to 2012 were identified from the Division of Digestive Surgery database. Bivariate analysis and multivariate logistic regression analysis identified prediction of morbidity and mortality. ROC curve estimation is use to determined the cut-off value of the predictive score.Results: Of 138 patients who underwent pancreaticoduodenectomy, 27 patients (19.6%) died. The predictor of mortality are serum total bilirubin ≥ 10 mg/dL, serum  creatinin ≥ 1.3 mg/dL, hematocrit ≤ 30%, serum albumin ≤ 3.0 g/dL and ASA status ≥ 3, with assign score 1, 1, 2, 1, 1, respectively. The cut-off value was 4 with 96% sensitivity and 91% specificity. The area under the receiver operator characteristic curve was 0.974 (SE 0.011; p < 0.001), which demonstrated a reasonable predictive value for the score.Conclusion: A total score of 4 or more is associated with increased postoperative mortality in patients underwent pancreaticoduodenectomy.
Overexpression of p53 in extra large (more than 10 cm) hepatocellular carcinoma Lalisang, Toar J.M.; Moenadjat, Yefta; Siregar, Nurjati C.; Stephanie, Marini
Medical Journal of Indonesia Vol 27, No 2 (2018): June
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (643.982 KB) | DOI: 10.13181/mji.v27i2.1980

Abstract

Background: Extra large hepatocellular carcinoma (HCC) of >10 cm managed in our center shows a specific characteristic in tropical regions. This type of HCC exhibits distinct p53 expression. This study aimed to determine the association between p53 expression and tumor size and behavior. Method: Subjects with HCC who underwent surgical resection in our hospital during 2012–2015 were enrolled in thisstudy. Subject’s characteristics, tumor size, histopathology findings, and tumor behavior were variables observed. Animmunohistochemical study on p53 expression was conducted to determine its association with those variables.Results: This study involved 38 subjects with tumor size ranging from 3 cm to 25 cm in diameter and 20 subjects (52.8%) with tumor size ranging from 10 cm to 25 cm in diameter. Only 13 samples were evaluated for p53 expression. Five subjects with >10 cm (extra large) tumor showed highly/overexpressed p53 (intensity>50%), two subjects with strong p53 expression (intensity>5%–50%), and two subjects with weak expression. Three subjects with <10 cm (large) tumor showed strong expression of p53 (5%–9%) and a subject with 3 cm tumor showed weak p53 expression (<5%). Highly expressed p53 was found in patients with microvascular invasion, inflammatory response, mitosis, and necrosis.Conclusion: Overexpression of p53 was associated with extra large and poorly differentiated HCC.
Biology of Glycocalyx: The Essential Role in Maintaining Epithelial Barrier: A Mini-Review Lalisang, Toar J.M.
The New Ropanasuri Journal of Surgery
Publisher : UI Scholars Hub

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Abstract

Hernia Through Winslow Foramen in Cipto Mangunkusumo General Hospital, Jakarta: A Case Report Ristiyanto, Eko; Wibowo, Taufik A; Syaiful, Ridho A; Philippi, Benny; Lalisang, Toar J.M.
The New Ropanasuri Journal of Surgery
Publisher : UI Scholars Hub

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Abstract

Introduction. Hernias through Winslow foramen are extremely rare, occurred for 0.1% of all abdominal hernias and found during laparotomy due to strangulated bowel obstruction. This study aims to describe hernia of Winslow foramen and its management. Method. Data were retrospectively collected based on medical records. Clinical manifestations, laboratory data, supporting radiographic examinations, treatment, postoperative care, and outcomes were collected. Case summary. We report the first case of Winslow foramen hernia at Cipto Mangunkusumo General Hospital, Jakarta. A man 54 years in 2019. Ileus was the main clinical symptoms and presented epigastric pain, nausea and vomiting. Plain abdominal x-ray confirmed small bowel obstruction but the etiology was unclear. Emergency laparotomy was performed and a herniated loop of ileum was found entering the lesser sac through the Winslow foramen. The loop of ileum was reduced and viable, omental patch was put on Winslow foramen as plasty procedure. Conclusion. Symptoms, clinical examination is non-specific and laboratory findings are rarely helpful. Retrograde analysis on the plain abdominal x-ray should be considered as abdominal internal hernia through Winslow foramen. The surgical management of hernia through Winslow foramen based on surgeon preference and the viability of the herniated intra-abdominal contents.
Co-Authors Adianto Nugroho Arnold Simanjuntak Bennardus Philippi Benny Philippi Bernardus Philippi Husniah Th-Akib Iwan Darmansjah Johannes Hudiono Marini Stephanie Nurjati C. Siregar Rianto Setiabudy Ristiyanto, Eko Soehartati Gondhowiarjo Syaiful, Ridho A Wibowo, Taufik A Yefta Moenadjat