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Managing Gallstone during Pregnancy Lalisang, Toar JM
Indonesian Journal of Obstetrics and Gynecology Volume. 1, No. 4, October 2013
Publisher : Indonesian Socety of Obstetrics and Gynecology

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Abstract

Transient physiological changes in the biliary system during pregnancy increased the risk of gallbladder diseases. Nonoperative management of symptomatic cholelithiasis increases the risk of complications of biliary lithiasis, such as cholecystitis and empyema, while obstruction common bile duct stones with or without cholangitisb and biliary pancreatitis raise maternal mortality. Delay in definitive surgical treatment of biliary diseases during pregnancy increases the likelihood acute biliary pancreatitis which impact on preterm delivery until fetal lost. Laparoscopic cholesystectomy during pregnancy has advantages for the mother in that it speeds up her recovery, giving her less pain and facilitated natural birth without a cesarean section. On the fetus side, laparoscopic cholecystectomy is safe since it does not induce preterm delivery or abortion. Identification of gallbladder stone during pregnancy warrant a preventive laparoscopic cholesystectomy or endoscopic CBD exploration, both of which promise good outcomes. [Indones J Obstet Gynecol 2013; 1-4: 219-21] Keywords: adult choledochal cyst, biliary cyst, biliary dilatation, mixed type
Managing Gallstone during Pregnancy Lalisang, Toar JM
Indonesian Journal of Obstetrics and Gynecology Volume. 1, No. 4, October 2013
Publisher : Indonesian Socety of Obstetrics and Gynecology

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (81.332 KB) | DOI: 10.32771/inajog.v1i4.370

Abstract

Transient physiological changes in the biliary system during pregnancy increased the risk of gallbladder diseases. Nonoperative management of symptomatic cholelithiasis increases the risk of complications of biliary lithiasis, such as cholecystitis and empyema, while obstruction common bile duct stones with or without cholangitisb and biliary pancreatitis raise maternal mortality. Delay in definitive surgical treatment of biliary diseases during pregnancy increases the likelihood acute biliary pancreatitis which impact on preterm delivery until fetal lost. Laparoscopic cholesystectomy during pregnancy has advantages for the mother in that it speeds up her recovery, giving her less pain and facilitated natural birth without a cesarean section. On the fetus side, laparoscopic cholecystectomy is safe since it does not induce preterm delivery or abortion. Identification of gallbladder stone during pregnancy warrant a preventive laparoscopic cholesystectomy or endoscopic CBD exploration, both of which promise good outcomes. [Indones J Obstet Gynecol 2013; 1-4: 219-21] Keywords: adult choledochal cyst, biliary cyst, biliary dilatation, mixed type
Diagnostic Approach and Treatment of Choledocholithiasis Gianawati, Indah; Sulaiman, Ali; Lesmana, L A; Lalisang, Toar JM; Abdullah, Arman A
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 5, ISSUE 2, August 2004
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (0.036 KB) | DOI: 10.24871/52200471-75

Abstract

Choledocolithiasis may cause acute cholangitis which is life-threatening condition. It has non specific clinical signs from mild to severe condition such as septicemia. Diagnostic and treatment modalities had developed a great deal recently. Therapeutic options include endoscopic retrograde cholangio pancreatography (ERCP),common bile duct exploration (CBDE), laparoscopic CBDE and stone retrieval. The important thing is to choose the appropriate method for each patient. We reported a case of choledocolithiasis in 40 years old, male patients who was clinically diagnosed as acute cholangitis. Diagnostic approach to find the etiology was done. Abdominal USG and CT were performed and showed multiple stones in gallbladder and intrahepatic biliary duct, suspected mass at caput of the pancreas and hepatomegaly. The ERCP showed dilatation of intra and extra hepatic biliary ducts with multiple stone in common bile duct (CBD), hepatic duct and gallbladder. The stent was placed for biliary drainage. The patient underwent cholecystectomy per laparoscopy, but further evaluation of the cholangiography still showed the presence of stones in intrahepatic biliary duct. Laparotomy exploration of CBD was done and it revealed multiple stones and dilatation of distal CBD. Surgical treatment selected for this case was choledocojejunostomy. Keywords: Choledocolithiasis, CBD, diagnostic approach
Diagnosis and Management of Barret'ƒs Esophagus Wijaya, Adi; D, Dharmika; Syam, Ari F; Lalisang, Toar JM
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 6, ISSUE 2, August 2005
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (0.036 KB) | DOI: 10.24871/62200542-47

Abstract

Incidence of esophageal adenocarcinoma is increasing in western countries and has poor prognosis due to late diagnosis. Barrett’s esophagus is considered as premalignant lesion in which some of squamous epithelium in distal esophagus has been replaced by metaplastic columnar ephithelium. It occurs as complication of longstanding gastroesophageal reflux. Endoscopic examination is very important for early detection especially in patients with chronic symptoms of gastroesophageal reflux disease (GERD) for more than 5 years. Aggressive antireflux treatment may reduce the risk of esophageal carcinoma. However, no single therapeutic modality had been proven superior compare to others, but until now surgery remains the most popular treatment of choice in the management of Barrett’s esophagus.   Keywords: Barrett’s esophagus,GERD, premalignant lesion, management
Characteristics of Pancreaticoduodenal Resection on Periampullary Tumor Cases by Jakarta Tertiary Hospital Team: Three Decade Report Lalisang, Toar JM; Mazni, Yarman; Moenadjad, Yefta; Matondang, Sahat
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 20, No 2 (2019): VOLUME 20, NUMBER 2, AUGUST 2019
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (591.318 KB) | DOI: 10.24871/202201966-72

Abstract

Background: There were only few publications related to pancreaticoduodenal resection (PDR) /Whipple procedure in Indonesia in the past decade.Method:  Retrospectively report of  the characteristics and outcomes of PDR performed by Cipto Mangunkusumo Hospital surgical team from 1993 to 2017 were collected.Results: PDR were performed in 213 patients, with a mean age of 50.6 years and 54.4% patients were females. Predominant preoperative clinical findings were jaundice (68.9%) and mild hypoalbuminemia (69.9%). Biliary decompression was performed in 112 (52.6%) subjects. Average surgical waiting time was 3.5 months. While PDR were performed in 84 (39.5%) subjects, pyloric preserving pancreaticoduodenal technique was predominated in 128 (59.8) and predominated,  especially during the latter years. Fifteen (9.0%) cases were benign. Thirty-one (14.6%) subjects underwent relaparotomy, 16 (51.6%) of whom died post-operatively. Overall operative mortality decreased from 16.9% to 5.5% in 2016, while resection rate generally increased over time, ranging from 2 - 21/year. Less than 10% of subjects survived for > 5 years, while < 20% survived for < 24 months.  Overall morbidity was 65.1% in 177 survivors, with surgical site infection in 52.5%, pancreatic fistula in 24.2%, and post-pancreatectomy haemorrhage (PPH) as a fatal postoperative complication in 19 (8.9%) cases. Patients who died within 30 days postoperatively had significantly more relaparotomies and PPH (p < 0.001).Conclusion: Prolonged jaundice and mild hypoalbuminemia are dominant characteristics in our Indonesian PDR subjects. Cipto Mangunkusumo Hospital is a high-volume PDR centre and world class hospital. Mortality rates decreased with the increasing resection rates. Relaparotomy and PPH are predictors of poor outcome.
Merit of APACHE II, MPI and ARPI scores as determinants On Demand Relaparotomy Kamil, Radhita F.; Lalisang, Toar JM; Kekalih, Aria
The New Ropanasuri Journal of Surgery
Publisher : UI Scholars Hub

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Abstract

Introduction. Delayed in decision making to carry out relaparotomy increases the morbidity and mortality. The decision to be made on demand relaparotomy is a kind of one subjectivity on the clinical setting. Therefore, it is necessary to have a thorough physical examination with additional diagnostic tools as the rationale to make an accurate decision that is the scoring system. There were many scoring systems has been proposed, and we run a study aimed to find out the merit of those scoring. Method. We run a case-control study enrolled 32 subjects with on demand relaparotomy and 64 subjects with laparotomy for any indication. APACHE II, MPI, ARPI scores were applied as variables. Data collected retrospectively from those who underwent laparotomy andrelaparotomy in RS dr.Cipto Mangunkusumo General Hospital in period of January 2012 to December 2013. These variables subjected to statistical analysis. Results. Based on statistical analysis of the two groups we found that APACHE II showed no significant difference (p = 0.114), whilst MPI and ARPI showed significant difference (p <0.0001). ROC curve showed that APACHE II had AUC of 59.2% with a cut-off point of 10, MPI had AUC of 86.4% with a cut-off point of 20 and ARPI had AUC of 77.6% with a cut-off point of 10. Conclusion. MPI and ARPI could be used as determinants on demand relaparotomy.
Hemorrhoid: Pathophysiology and Surgical Management A Literature reviews Lalisang, Toar JM
The New Ropanasuri Journal of Surgery
Publisher : UI Scholars Hub

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Abstract

How early is early…? The Role of Abdominal Reoperation Predictive Index at dr. Cipto Mangunkusumo General Hospital, Jakarta Marbun, Vania MG; Lalisang, Toar JM
The New Ropanasuri Journal of Surgery
Publisher : UI Scholars Hub

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Abstract

Introduction. Determining the right timing of relaparotomy has always been a challenge and hence a simple objective value is required. Abdominal reoperative predictive index (ARPI) proposed to decide when to reoperate. The study aimed to ascertain whether ARPI could be applied in decision making for relaparotomy at dr.Cipto Mangunkusumo General Hospital (RSCM), Jakarta. Method. A cross sectional study carried out on those underwent relaparotomy in Department of Surgery at RSCM during period of 2009–2015. The follow–up carried out by the residents under supervision of attending surgeons, the laboratory findings were reviewed and tabulated in accordance with clinical variables of ARPI. Eight variables of ARPI were reviewed in these subjects. Results. There were 30 subjects reviewed. In this study there were four frequent variables, i.e. persistent symptoms (for more than 4 days after relaparotomy), abdominal pain (that remains for 48 hours after relaparotomy), surgical site infection (90%), and ileus (70%). Seventy–three–point three percent carried out in more than 7 days after primary operation, while as only 10 percent underwent relaparotomy less than 4 days after primary operation. Conclusion. ARPI is practical guide and may be implemented in helping surgeons to decide relaparotomy should there required. Low compliance lead to delay in the management and associated with high mortality.
Gallstone Ileus in Cipto Mangunkusumo General Hospital, Jakarta: A Case Series Lalisang, Toar JM; Hehuwat, Georgina P.; Lalisang, Arnetta NL; Pratama, Irfan K.; Mazni, Yarman
The New Ropanasuri Journal of Surgery
Publisher : UI Scholars Hub

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Abstract

Introduction. Gallstone ileus is an uncommon mechanical bowel obstruction caused by a gallstone in the gastrointestinal tract which enters due to bile-enteric fistulae. This study aims to describe gallstone ileus and its management. Method. Data were retrospectively collected from medical records. Clinical manifestations, laboratory data, supporting radiographic examinations, treatment, postoperative care, and outcomes were collected. Results. We report two gallstone ileus cases at Cipto Mangunkusumo General Hospital, Jakarta which admitted in the last 20 years. The first case was a woman 33 years in 2002 and the second was man 45 years in 2017. Ileus was the main clinical symptoms. Gallstone ileus was diagnosed with preoperatively based on clinical and radiology findings. Laparotomy was performed and ileostomy for stones evacuation and cholecystectomy were performed without bile-enteric fistula repair. Large black stones were found at terminal ileum which made the obstruction. Conclusion. Gallstone ileus was an uncommon disease which can be treated and has a good prognosis. Plain abdominal x-ray has an important role in diagnosis and treatment approach.