Hipoalbuminemia prabedah sebagai faktor prognostik enterokolitis pascabedah penderita megakolon kongenital (Hirschsprungs disease) = Preoperative hypoalbuminemia as a prognostic factor of postoperative enterocolitis in


Background: Hirschsprungs disease or congenital megacolon is the congenital absence of ganglion cells in the colon. The rectum is always involved and in 90% of patients the abnormality is confi ned to the rectum and sigmoid. Absence of ganglion cells prevents peristalsis, resulting in functional obstruction. The success of Hirschsprungs treatment depends on many factors such as age at the time of operation, body weight, hemoglobin levels, albumin levels, length of operation, length of stay and other prognostic factors. Post operative enterocolitis and other complications still represent as the problem wich often are faced by pediatric surgeons. Objective: The aim of this study was to evaluate the effect of albumin levels on postoperative enterocolitis in children presenting with congenital megacolon. Method: We conducted an ambidirectional cohort study involving children presenting with Hirschsprungs disease in Dr. Sardjito, Panti Rapih and Permata Husada hospitals in Yogyakarta city from January 2005 to December 2010. All children had been operated using ERPT and PSNRHD methods. The subjects were classifi ed into normoalbuminemia (>3.5 g/dl) and hypoalbuminemia (&#88043.5 g/dl). The effect of albumin levels on postoperative enterocolitis were indicated by relative risk and 95% confi dence interval. Results: Out of 104 children with Hirschsprungs disease, 53 (51%) were hypoalbuminemic and 51 (49%) were normoalbuminemia. Postoperative enterocolitis was found in 18 (17.3%) children, 11/18 (61.1%) of them were hypoalbuminemia, whereas 7/18 (38.9%) were normoalbuminemia. Albumin levels were not signifi cant prognostic factor for postoperative enterocolitis in children with congenital megacolon (RR=1.5195% CI:0.64-3.60p=0.34). Conclusion: The albumin levels are not prognostic factor for postoperative enterocolitis in children with congenital megacolon. Latar belakang: Penyakit Hirschsprung atau megakolon kongenital adalah kelainan kongenital berupa ketiadaan sel ganglion pada kolon. Rektum selalu terlibat dan 90% kelainan ini didapatkan pada rektum dan sigmoid. Ketiadaan sel ganglion akan menyebabkan gangguan peristaltik sehingga mengakibatkan terjadinya ileus fungsional. Keberhasilan terapi tergantung pada beberapa faktor antara lain umur saat operasi, berat badan, kadar hemoglobin, albumin, lama operasi, lama perawatan, dan faktor-faktor prognostik lainnya. Enterokolitis dan komplikasi pascabedah lainnya masih merupakan masalah yang harus dihadapi oleh para ahli bedah anak. Tujuan: Menilai pengaruh kadar albumin prabedah terhadap kejadian enterokolitis pascabedah pada penderita penyakit megakolon kongenital. Metode: Penelitian dilakukan dengan desain kohort ambidireksional pada anak dengan penyakit Hirschsprung yang dilakukan operasi dengan metode ERPT dan PSNRHD di RSUP Dr. Sardjito, RS Panti Rapih, dan RS Permata Husada Yogyakarta. Kadar albumin dibedakan menjadi normoalbuminemia (>3,5 g/dl) dan hipoalbuminemia (&#88043,5 g/dl). Kadar albumin prabedah sebagai faktor prognostik enterokolitis pascabedah dinyatakan dengan RR dan IK 95%. Hasil: Dari 104 anak dengan penyakit Hirschsprung, diperoleh 53 (51%) anak dengan hipoalbuminemia dan 51 (49%) anak dengan normoalbuminemia. Enterokolitis pascabedah terjadi pada 18 (17,3%) anak, diantaranya terdapat 11 (61,1%) anak dengan hipoalbuminemia dan 7 (38,9%) anak dengan normoalbuminemia. Kadar albumin bukan merupakan faktor prognostik enterokolitis pascabedah pada anak megakolon kongenital (RR=1,51IK 95%:0,64-3,60p=0,34). Simpulan: Kadar albumin bukan merupakan faktor prognostik enterokolitis pascabedah pada anak dengan megakolon kongenital. KATA KUNCI: enterokolitis pascabedah, kadar albumin prabedah, penyakit megakolon kongenita

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This paper was published in UGM Journals, OAI Repository.

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