JBN (Jurnal Bedah Nasional) is an Open Access Journal focusing on research, case, and review in the field of surgical science or surgical-related science.
Program Studi Ilmu Bedah, Fakultas Kedokteran Universitas Udayana
Lesi B3 Payudara: Jinak di Atas Kertas, Berisiko di Baliknya
Hak Cipta (c) 2026 JBN (Jurnal Bedah Nasional) https://creativecommons.org/licenses/by-nc-sa/4.0
Correlation Between Saphenous Vein Diameter and Outcomes of Endovenous Laser Ablation in Patients with Varicose Veins: A Systematic Review
Aim: This systematic review aims to determine whether preoperative saphenous vein diameter influence the success rate outcomes of endovenous laser ablation (EVLA) in patient with varicose veins. Methods: A Systematic Review with a comprehensive search for articles published in the last decade was performed on ScienceDirect and PubMed. After screening process, three high quality studies about the correlation between preoperative saphenous vein diameter and outcomes of EVLA procedure success were identified on inclusion criteria. The Newcastle-Ottawa Scale (NOS) was employed to assess the quality. Results: The larger diameter of saphenous vein is an independent risk factor predictor of technical failure, as consistently demonstrated by the synthesis of the included studies (n=3). Veins measuring greater than 12 mm in was associated with a higher incidence of partial recanalization compared with smaller diameter veins. According to the research’s review that EVLA is effective but the effectiveness depends largely on the energy-to-diameter ratio. To achieve sustained fibrotic occlusion, larger veins need a higher Linear Endovenous Energy Density (LEED). Conclusion: The diameter of the saphenous vein is a key predictor of EVLA performance. While a larger diameters are linked to an increased risk of recanalization, tailored procedural strategies such as a higher energy delivery, optimized tumescent compression and the use of advanced laser technologies may improve outcomes. Accurate preoperative measurement of vein diameter is essential for patient selection and personalize treatment planning.
Surgical Anatomy of the Hand and Its Clinical Relevance in Burn Reconstruction and Post-Burn Contracture Management: A Narrative Literature Review
Background: The hand is a highly complex anatomical structure essential for functional, sensory, and aesthetic performance. Burn injuries frequently involve the hand and often result in contractures, deformities, and functional impairment requiring reconstructive surgery. A thorough understanding of surgical anatomy is fundamental for optimizing reconstructive outcomes. Objective: This literature review aims to summarize the surgical anatomy of the hand and its relevance in burn reconstruction and post-burn contracture management. Methods: A narrative literature review was conducted using anatomical and surgical references. Anatomical structures, mechanisms of contracture formation, and reconstructive surgical strategies were synthesized. Results: The hand consists of integrated integumentary, musculoskeletal, neural, and vascular systems that enable fine motor control. Burn injuries commonly result in skin loss, scar contracture, tendon adhesion, joint stiffness, and deformities such as boutonniere deformity and syndactyly. Surgical management includes contracture release, Z-plasty, skin grafting, and flap reconstruction. Conclusion: Comprehensive knowledge of hand surgical anatomy is crucial for effective burn reconstruction. Detailed anatomical understanding allows surgeons to select appropriate surgical approaches and improve functional and aesthetic outcomes.
Silicone versus Metallic Tracheobronchial Stents for Malignant Central Airway Obstruction: A Systematic Review and Meta-Analysis
Introduction: Malignant central airway obstruction (MCAO) is a critical complication of advanced thoracic malignancy that can rapidly lead to respiratory failure. Airway stenting remains one of the most effective palliative interventions, yet the relative efficacy and safety of silicone versus metallic stents remain uncertain. Objective: This meta-analysis aimed to compare clinical outcomes between silicone and metallic tracheobronchial stents in patients with malignant central airway obstruction. Methods: A systematic search was conducted across PubMed, Cochrane Library, and ScienceDirect databases from inception to October 2025. Studies were included if they compared silicone and metallic stents in adult patients with MCAO and reported at least one relevant outcome. Data extraction and quality assessment followed PRISMA guidelines, and pooled analyses were performed using random- or fixed-effects models as appropriate. The primary outcomes were overall complication rate, short-term (30-day) mortality, dyspnea symptom improvement, and incidence of granulation tissue formation. Results: Seven comparative cohort studies encompassing 358 patients were included. The pooled analyses revealed no statistically significant difference between silicone and metallic stents for overall complications (RR = 1.13, 95% CI 0.61–2.09, p = 0.71), 30-day mortality (RR = 0.97, 95% CI 0.80–1.17, p = 0.72), dyspnea improvement (RR = 1.03, 95% CI 0.74–1.43, p = 0.87), or granulation tissue formation (RR = 1.09, 95% CI 0.61–1.96, p = 0.78). Moderate heterogeneity was observed for complication and granulation outcomes but did not affect the direction of results. Both stent types achieved similar technical success, airway patency, and symptomatic relief. Discussion: The results indicate that silicone and metallic stents provide comparable clinical benefits and safety profiles for palliative management of malignant airway obstruction. The minor differences observed across studies likely reflect variations in device design, airway anatomy, and procedural expertise rather than material superiority. Given the absence of clear advantage for either stent, clinical decision-making should focus on individualized patient factors and procedural logistics. Conclusion: Silicone and metallic tracheobronchial stents demonstrate equivalent performance in the palliation of malignant central airway obstruction. The choice between them should be guided by patient condition, airway anatomy, and operator experience rather than intrinsic material properties. Future prospective studies incorporating hybrid and customized stent technologies are needed to define optimal strategies for airway restoration in advanced thoracic malignancy.
Temporomandibular Joint Ankylosis and Mandibular Hypoplasia Due to Neglected Pediatric Mandibular Condyle Fracture: A Case Report
ABSTRACT INTRODUCTION: The clinical importance of ankylosis in children is concerning with its massive effect and disturbance on the mandibular growth causing deformity apart from the limited mouth opening. Trauma (neglected or abandoned condylar or subcondylar fracture) is the most common cause of bony and fibrous ankylosis. History, physical examination and radiographical examination of each patient with ankylosis of temporomandibular joint is mandatory in arriving to a final diagnosis, severity, involvement of adjacent structures and ultimately to plan the treatment. CASE PRESENTATION: A seventeen years old male presented with her family seeking solution for a severely limited mouth opening. From the history, the child has suffered from height fall at the age of 8 years old. He had complained from swelling and pain near the ear, treated by analgesics, gradually subsided and neglected. This limitation affects on feeding and had an impact on the child’s health, seeking for management for the condition became mandatory. Clinical examination, radiographical examination is prepared in beside that ethical approval with full discussion with the parents done. DISCUSSION: Patients with ankylosis are considered as serious problem. Not only because it is rare, but it also affects the growth and development of the one’s mandible as the center growth of mandible occurs at the condyles, it’s not just because of ankylosis. Surgeons should keep in their minds that well experienced anesthetist is important; also extension of the ankylosed bone with amount of cutting is important and reankylosis as a complication must be avoided. CONCLUSION: The surgeons agree with the statement that success in the preventing reankylosis after condylectomy. Its primarily refers to the early postoperative physiotherapy, maintained on a long term. Keywords: temporomandibular joint, condylectomy, mandibular hypoplasia
Comprehensive Reconstruction of Facial Defects: A Case Study Utilizing Combined Skin Flap Techniques and Composite Graft Chondrocutaneus
Background: Post-operative defects of skin tumor removal in the facial area, especially the nasal area, are very common. Reconstruction of defects in the nasal, presents a great challenge for surgeons where the presence of asymmetric conditions, changes in skin color and texture will be easily visible and cause changes in facial shape. In addition, to maintain and restore the function of the defective part that will be reconstructed, it requires high precision and expertise to obtain good results aesthetically and functionally. Methods: In this article, we present 3 cases of the combined use of auricular chondrocutaneous composite graft and paramedian forehead flap in defect reconstruction full tickness nasal ala after tumor excision. Two cases were unilateral reconstruction and 1 other case was bilateral reconstruction. Previously, the patient had been educated about the choice of surgical technique, risks and benefits of the surgical technique to be used and the patient had agreed to it. Results: The reconstruction results in all three cases showed excellent results both aesthetically and functionally. The shape and contour of the thin auricular cartilage are very suitable for forming the nasal ala without the need for surgical molding as in other cartilage graft donors. The thin skin attached to the cartilage not only forms liningwhich is perfect but also forms a wide nostril space. The weakness of the auricular chondrocutaneous composite graft in terms of vascularization supply can be overcome with paramedian forehead flap, which is also a large skin donor with contours and skin color that are most similar to the skin of the nasal. Conclusion: This procedure provides excellent results in terms of aesthetics and functionality, as well as minimal complications and donor mobility, so it can be the procedure of choice for reconstruction of large defects in the nasal after tumor removal.
Right-Sided Congenital Diaphragmatic Hernia Presenting with Liver, Ileum, Caecum, & Transverse Colon Herniated into Thoracic Cavity in 2 years old Child: A Rare Case Report
One of the congenital abnormalities that can be found in children is congenital diaphragmatic hernia. The prevalence of left-sided congenital diaphragmatic hernias is higher than right-sided congenital diaphragmatic hernias. This situation causes organs in the abdominal cavity to be pushed into the thoracic cavity. The diagnosis of this condition can usually be made when the patient is still a baby, both clinically and radiologically. The appropriate treatment that can be done for patients with this condition is surgery. In this case report, we describe a patient with a right congenital hernia which was confirmed based on clinical findings and radiology results. The patient underwent surgery in the form of a hernia repair. This case report also discusses the management of a patient with a right congenital hernia.
Pendekatan dan Luaran Bedah Minimal Invasif untuk Penyakit Jantung Kongenital pada Anak: Tinjauan Literatur
Pendahuluan Penyakit jantung bawaan (PJB) merupakan salah satu penyebab utama kematian bayi, terutama di Asia Tenggara. Perbaikan bedah konvensional melalui sternotomi median, meskipun efektif, sering kali menyebabkan trauma yang signifikan, jaringan parut yang besar, dan waktu pemulihan yang lebih lama. Bedah jantung invasif minimal (Minimally Invasive Cardiac Surgery) muncul sebagai alternatif yang kurang invasif, dengan potensi memberikan pemulihan lebih cepat dan hasil kosmetik yang lebih baik. Metode Tinjauan literatur dilakukan dengan menggunakan basis data PubMed, Cochrane, ScienceDirect, Google Scholar, dan SCOPUS untuk penelitian yang diterbitkan antara tahun 2014 hingga 2024. Kata kunci yang digunakan meliputi “Congenital Heart Disease,” “Minimally Invasive Surgery,” dan “Mini Thoracotomy.” Dari 63 studi awal, 5 artikel relevan dipilih berdasarkan kriteria yang telah ditentukan sebelumnya. Diskusi Tinjauan menunjukkan bahwa pendekatan bedah invasif minimal dapat mengurangi trauma pembedahan, risiko infeksi, dan lama rawat inap, serta meningkatkan kepuasan pasien karena luka sayatan yang lebih kecil. Tantangannya meliputi kebutuhan akan keterampilan dan peralatan khusus, serta kurva pembelajaran yang dapat memperpanjang waktu operasi pada tahap awal. Tingkat morbiditas dan mortalitas serupa dengan metode konvensional, sehingga pemilihan pasien yang tepat sangat penting untuk mencapai hasil optimal. Kesimpulan Bedah invasif minimal untuk PJB memberikan manfaat signifikan seperti pemulihan lebih cepat dan hasil kosmetik yang lebih baik tanpa mengorbankan aspek keselamatan. Meskipun memerlukan keterampilan teknis dan sumber daya tambahan, MICS merupakan alternatif yang menjanjikan terhadap sternotomi. Diperlukan penelitian lebih lanjut untuk memastikan hasil jangka panjang dan mendukung penerapan yang lebih luas.
Facial and Lip Reconstruction due to Animal Bite with Local Advancement Flap and Estlander Flap: A Case Series
Background: Animal bites frequently result in facial disfigurement, as well as crush and avulsion injuries due to their sharp teeth and powerful jaws, and facial and lip reconstruction due to dog bite is a challenging surgical procedure with a high level of difficulty. Case: This case series reports three patients with facial and lip defects following dog bites: a 41-year-old female with an open degloving wound up to 10 x 3 cm involving the right upper and lower eyelids with partial loss of upper lateral cartilage and inner lining of nasal mucosa and complete loss of lower lateral cartilage managed with local advancement flap followed by planned alarplasty and rhinoplasty; a 23-year-old male with a full-thickness defect at the lateral one-third of the upper lip with 5 x 1.5 cm soft tissue loss; and a 7-year-old girl with a full-thickness defect at the lateral one-third of the upper lip with 3 x 1 cm soft tissue loss, both managed with Estlander flap. All surgeries went uneventful without significant complications, and three-months follow-up showed viable flaps with satisfactory aesthetic and functional outcomes in all patients. Conclusion: Estlander flap can be used for primary lip reconstruction, defects at the oral commissure, and reconstruction of defects ranging from one-third to two-thirds of the lip, including the corner of the mouth, making it an excellent alternative for preserving facial aesthetics and function in facial and lip injuries caused by dog bites.
Anak Agung Istri Ayu Detritha Sarasmartha Putri
Severe Mentosternal Contracture Release and Reconstruction with Anterolateral Thigh Flap: A Case Series
Background: Post-burn contracture (PBC) of the neck is one of the most common burn sequelae and may cause restriction of neck movement and mouth closure, breathing difficulties, and cosmetic disfigurements, making its management a challenging surgical procedure. Case: Two patients, a 37-year-old female and a 14-year-old male, presented with difficulty in straightening the neck and were diagnosed with post-burn mentosternal contracture Onah classification type III; both underwent contracture release and defect reconstruction using anterolateral thigh (ALT) flap with defect sizes of 10 cm x 8 cm on the right side and 15 cm x 8 cm on the left side, elevated 1–5 mm. The surgeries went uneventful and, at one-month follow-up, both patients showed increased neck mobility with viable flaps. Conclusion: The aims of contracture release and reconstruction in PBC are to restore cervical mobility and improve appearance, and ALT flap represents an excellent option that provides good pliability, thin skin, less hair, good donor-site recovery, acceptable skin color match, minimal donor-site morbidity, and an adequate amount of tissue to cover large post-release defects when local flaps are unavailable or suboptimal due to burn injury.
Rare Spigelian Hernia in a Young Adult: Clinical Presentation, Diagnosis, Surgical Management, and Review of the Literature
Background: Spigelian hernia is a rare type of ventral hernia, occurring through the Spigelian aponeurosis at the linea semilunaris. It typically presents in patients aged 40–70 years, with a higher frequency on the right side. Diagnosis is often delayed due to its subtle symptoms and location, making it a challenge to detect early. Objective: This case report aims to describe a rare instance of Spigelian hernia in a 28-year-old male, highlighting the clinical presentation, diagnostic process, and management approach. Case Report: A 28-year-old male mechanic presented with a right lower abdominal bulge, which increased in size upon physical exertion, such as during sit-ups or when coughing. Initial physical examination revealed a palpable, reducible mass in the right lower abdomen. Imaging confirmed the presence of a Spigelian hernia. Conclusion: Spigelian hernia, while rare, should be considered in young patients presenting with abdominal bulges, especially when accompanied by intermittent pain and activity-induced exacerbation. Early diagnosis and surgical intervention are essential to prevent complications such as incarceration or strangulation.
Bilateral Inguinal Canal Cryptorchidism in an 18-Month-Old: A Case Report and Brief Review
Background: Cryptorchidism (undescended testis, UDT) is the most common congenital anomaly of the male genitalia, defined by absence of one or both testes from the scrotum. Testes may arrest anywhere along the path of descent—most commonly within the inguinal canal—and, less often, in ectopic locations. Case Presentation: A healthy 18-month-old boy was brought by his mother with concern that the right testis had not descended. On examination, both hemiscrota were empty with no palpable testes. Ultrasonography demonstrated no intrascrotal testes; testicular shadows with homogeneous echotexture were identified within the inguinal canal bilaterally (right: ~0.90 × 0.44 × 1.08 cm; left: ~0.90 × 0.61 × 1.33 cm). Findings were consistent with bilateral inguinal-canal cryptorchidism. Conclusion: This case underscores the primacy of systematic physical examination—supported by targeted ultrasonography for localization—in evaluating suspected UDT. Given age >12 months and inguinal-canal location, orchiopexy is recommended, ideally before 18 months, to optimize testicular growth and reduce long-term risks (subfertility, malignancy, torsion). Hormonal therapy (e.g., human chorionic gonadotropin/hCG) may be considered in select circumstances but is generally less effective than surgery. Early referral and timely operative management remain the standard of care.
Enhanced Recovery After Surgery (ERAS) Protocols in Colorectal Cancer Surgery: Impact on Postoperative Outcomes
Aim: ERAS protocol has emerged as a transformative approach to perioperative care in colorectal cancer surgery in which postoperative morbidity remains significant. By integrating evidence-based interventions, ERAS protocol accelerates patients’ recovery and reduces surgical morbidity, which in turn shortens patients’ length of hospital stay. This literature review evaluates current evidence regarding the impact of ERAS implementation on postoperative outcomes in patients undergoing colorectal cancer resections. Methods: A narrative literature review was conducted using recent studies published within the last 10 years. Studies evaluating ERAS implementation in colorectal cancer resections and reporting outcomes such as post-operative complications, length of stay, and patient’s functional recovery were included. Results: Across the reviewed literature, ERAS protocols consistently demonstrated improvements in multiple postoperative outcomes. Most studies reported a significant reduction in over 90% for minimal and moderate complications. ERAS also consistently shortens hospital length of stay, particularly through early nasogastric tube removal and optimized perioperative fluid and dietary management. Early mobilization and structured recovery components improve postoperative functional recovery, supporting a faster return to preoperative activity levels. Conclusion: The ERAS protocol integrates multiple evidence-based interventions that collectively reduce operative stress and enhance patient recovery. Current evidence demonstrates that ERAS implementation significantly decreases postoperative complications and shortens hospital length of stay, while also offering a cost-effective approach to perioperative management.
Thyroid Malignancy in Clinically Benign Cystic Thyroid Nodule Presentation
Aim: Cystic thyroid nodule (CTN) is almost always considered benign (noncancerous). Approximately 1% of people with cystic nodules will develop cancer, but less than 3% of those with partly cystic nodules who do not exhibit any suspicious symptoms will do so. In contemporary clinical practice, the most dependable diagnostic method for choosing patients for surgery is fine-needle aspiration biopsy (FNAC). However, because to the high frequency of insufficient smears and false-negative findings, FNAC has significant limits in instances with CTN. Two patients with cystic thyroid nodules were presented in this case report; however, further anatomical pathology reports following total thyroidectomy surgery revealed that the nodules were malignant. Case Presentation: This case report describes two cases of thyroid nodule patients who presented to Prof. Dr. RD Kandou Hospital. These patients had cystic thyroid nodules and subsequently underwent thyroidectomy due to large masses. Pathological examination was conducted and confirmed thyroid malignancy in both cases, specifically follicular variant papillary thyroid carcinoma. Conclusion: Ultrasound and FNAC examinations have limitations in detecting thyroid malignancies especially for large cystic thyroid nodule. Large nodule sizes and the inability to sample the whole lesion may potentially contribute to false negative results in FNAC. The experience of the operator also will determine the occurrence of false negatives in the ultrasound. Therefore, as clinician we should be aware there were potency of malignancy even in cystic thyroid nodule cases.
Hak Cipta (c) 2025 JBN (Jurnal Bedah Nasional) https://creativecommons.org/licenses/by-nc-sa/4.0
Studi Analisis dan Literature Review Tentang Perbandingan Glasgow Outcome Scale-Extended (GOS-E) dan Disability Rating Scale (DRS) dalam Penilaian Hasil Cedera Otak Traumatik
Tujuan: Penilaian hasil klinis pada pasien dengan cedera otak traumatis (COT) merupakan komponen penting dalam menentukan prognosis dan merencanakan intervensi terapeutik yang tepat. Review artikel ini membahas mengenai perbandingan, kelebihan dan kelemahan Glasgow Outcome Scale-Extended (GOS-E) dan Disability Rating Scale (DRS) pada pasien Cedera otak traumatik. Metode: Artikel ini merupakan suatu studi literatur yang membahas mengenai kelebihan dan kelemahan GOS-E dan DRS serta pemanfaatannya dalam management cedera otak traumatik. Seleksi artikel dilakukan secara purposive dari 20 jurnal. Hasil: GOS-E memberikan evaluasi yang lebih terperinci mengenai tingkat pemulihan pasien dengan mengkategorikan hasil ke dalam delapan tingkat, mulai dari kematian hingga pemulihan penuh. Di sisi lain, DRS menilai tingkat disabilitas dan pemulihan dengan fokus pada kesadaran, fungsi motorik, dan aktivitas sehari-hari. Ditemukan bahwa meskipun GOS-E menawarkan detail yang lebih dalam mengenai hasil jangka panjang, DRS lebih mudah digunakan dan lebih cepat dalam administrasi. Kesimpulan: GOS-E dan DRS memiliki kekuatan dalam prediksi luaran jangka Panjang, sedangkan DRS memiliki kelebihan dari segi kemudahan dalam evaluasi dan pengaplikasian. Hasil dari tinjauan ini diharapkan dapat memberikan wawasan yang lebih baik bagi praktisi klinis dalam memilih alat penilaian yang paling sesuai Aim: The assessment of clinical outcomes in patients with traumatic brain injury (TBI) is an essential component in determining prognosis and planning appropriate therapeutic interventions. This review article discusses the comparison, advantages, and limitations of the Glasgow Outcome Scale-Extended (GOS-E) and the Disability Rating Scale (DRS) in patients with traumatic brain injury.Method: This article is a literature review that examines the strengths and weaknesses of GOS-E and DRS, as well as their utilization in the management of traumatic brain injury. Article selection was carried out purposively from 20 journals. Results: GOS-E provides a more detailed evaluation of patient recovery by categorizing outcomes into eight levels, ranging from death to full recovery. On the other hand, DRS assesses the degree of disability and recovery with a focus on consciousness, motor function, and daily activities. It was found that although GOS-E offers more in-depth details regarding long-term outcomes, DRS is easier to use and quicker to administer. Conclusion: Both GOS-E and DRS have strengths in predicting long-term outcomes, while DRS has the advantage of being simpler to evaluate and apply. The findings of this review are expected to provide better insights for clinical practitioners in selecting the most appropriate assessment tool.
Aim: Kikuchi disease, often referred to as Kikuchi–Fujimoto disease (KFD), is an uncommon benign cervical lymphadenitis etiology. Cervical lymphadenopathy is Kikuchi disease's most prevalent clinical sign. The incidence of Kikuchi disease is reported more in young adult women. Case Presentation: We report a rare instance of parotid gland Kikuchi-Fujimoto disease (KFD). A 36-year-old woman presented to our department with a left preauricular tumor that had been present for three weeks. His Ultrasound revealed a well-defined anechoic cystic lesion with solid components in the preauricular area of the left jugular upper. FNAB was done and the results was an adenoma pleiomorfik with supurative inflammation. The patient underwent parotidectomy surgery and specimens sent to pathologic anatomic department. Patient confirmed with Kikuchi disease of parotid gland based on pathologic examination. Conclusion: Although rare, Kikuchi disease can be manifest in parotid gland and mimic parotid gland neoplasm. Complete assessment must be done to make right diagnosis to give appropriate treatment to the patient.
Simultaneous Extended Right Hemicolectomy and Anterior Resection For Synchronous Colon Cancer: A Case Report
Aim: The aim of this case report was to study the importance of comprehensive examinations of synchronous cancer to avoid repeated surgeries and improved the outcome. Case Presentation: a 77-years-old man with sigmoid adenocarcinoma and ascending colon mass was suspected to be a synchronous tumor. The patient complained difficulty in defecation accompanied with weight loss and change of bowel habit, especially hardened and bloody stool. Abdominal CT-scan showed thickened irregular diffuse along the ascending colon to caecum and colonoscopy found circular mass, 30-35cm from the anal verge. The extended right hemicolectomy and anterior resection were performed. There were no notable issues, hence we performed ileal colon and colorectal anastomoses. Pathological result for both specimens were adenocarcinoma. Patient was uneventful and discharged 4 days after the surgery. Conclusion: Synchronous CRC was an independent prognostic factor associated with poor overal survival and disease free survival. The primary treatment of synchronous colorectal cancer is surgical resection. Simultaneous right colectomy and anterior resection can be considered for synchronous colorectal malignancies to avoid repeated surgeries, ensuring a similar or potentially improved outcome.
Meckel's Diverticulitis Causing Acute Intestinal Obstruction in Rural Area: a Rare Case Report
Aim: To study acute intestinal obstruction as complication of Meckel’s diverticulitis in rural area. Case Presentation: A 13-year-old boy presented with diffuse abdominal pain, nausea, vomiting, and abdominal distension persisting for four days. The abdominal X-ray revealed dilated bowel loops and air-fluid levels, indicating obstruction. During exploratory laparotomy, a mesodiverticular band compressing the ileum was identified, along with a perforated Meckel’s diverticulum approximately 100 cm proximal to the ileocecal junction. The trapped intestinal loop was released, and the diverticulum was resected. The procedure included peritoneal lavage and drain placement. The patient was closely monitored postoperatively, with further management tailored according to clinical progress and histopathological findings. Conclusion: This case underscores the importance of early diagnosis and individualized surgical strategies in complicated Meckel’s diverticulum, particularly in resource-limited settings. Open laparotomy remains the preferred method for severe cases involving perforation or obstruction
Low Immunoscores CD3/CD8 and CD3/CD45RO are Associated with The Low Survival Rate of Triple Negative Breast Cancer Patients
Aim: Triple-negative breast cancer (TNBC) is associated with a highly aggressive clinical course, contributing to poorer patient outcomes and higher mortality rates. Current prognostic tools do not fully capture the complexities of the tumor immune microenvironment, particularly the role of effector lymphocytes (CD3, CD8, and CD45RO). Therefore, this study was conducted to investigate the prognostic significance of the immune markers CD3, CD8, and CD45RO within the tumor microenvironment of TNBC patients. Methods: This retrospective cohort study involved women aged >18 years old diagnosed with TNBC. Immunohistochemistry (IHC) for CD3, CD8, and CD45RO was performed using the Novolink system. Two pathologists independently assessed cell density in the tumor center (CT) and invasive margin (IM). Densities were classified as high or low using ROC curves, and the immunoscores (CD3/CD8, CD3/CD45RO) were grouped into low (I0, I1) and high (I2, I3, I4). Two-year mortality and clinical data were collected from medical records. Survival rates were analyzed using Kaplan-Meier and compared with the log-rank test. Results: The 2-year survival rate for TNBC patients was 58.3%, with a mean survival time of 18.95 months. Low CD3/CD8 was associated with significantly lower survival compared to high CD3/CD8 (42.9% vs. 73%; p=0.013), with mean survival times of 17.03 vs. 20.80 months. Similarly, low CD3/CD45RO had lower survival than high CD3/CD45RO (38.5% vs. 69.6%; p=0.01), with mean survival times of 16.37 vs. 20.43 months. Conclusion: Low CD3/CD8 and CD3/CD45RO immunoscores are associated with low survival in TNBC patients.
Ni Gusti Ayu Agung Manik Yuniawaty Wetan
The Relationship between Obesity, Intraoperative Blood Loss, NLR, and CRP with Perioperative Complications in Colorectal Cancer Surgery
Aim: This study examines the relationship between obesity, intraoperative blood loss, and systemic inflammatory responses (NLR and CRP) concerning perioperative complications in colorectal cancer surgery. Methods: A retrospective analytical observational study was conducted on 96 patients who underwent colorectal cancer surgery from January 1 to August 31, 2023. The analysis included obesity history, intraoperative blood loss, NLR, and CRP levels, using descriptive statistics, Chi-Square tests for Odds Ratios (OR), and logistic regression for adjusted odds ratios. Results: The study found a 38.5% complication rate in patients with BMI ≥25 kg/m² (OR=35) and a 29.5% rate in those with CRP >150 mg/L (OR=7). Patients with NLR >3 had a 21.1% complication rate (OR=1.3), while those with intraoperative blood loss >800 mL faced an 83.3% complication rate (OR=36). Logistic regression indicated that obesity and CRP are independently associated with major complications. Conclusion: Obesity, intraoperative blood loss, NLR, and CRP collectively influence major perioperative complications, with obesity and CRP being the most significant independent factors in colorectal cancer surgery.
Hak Cipta (c) 2025 https://creativecommons.org/licenses/by-nc-sa/4.0