Managemen Non-Operatif pada Perforasi Lambung dengan Prognosis Buruk di Malang : Sebuah Studi Observasional

Didiek Darmadi Tri Setyo; Setyo Sugiharto

doi:10.17977/um062v7i32025p142-150

Authors

Didiek Darmadi Tri Setyo Universitas Negeri Malang
Setyo Sugiharto RSUD Saiful Anwar Malang

DOI:

https://doi.org/10.17977/um062v7i32025p142-150

Keywords:

poor prognosis gastric perforation, non-operative management, peritoneal drainage, perforasi lambung prognosis buruk, manajemen non-operatif, drainase peritoneal

Abstract

Abstract: Gastric perforation accounts for 25 to 30 percent of acute abdomen cases in emergency departments, with high mortality and morbidity rates. This study presents non-operative management as an alternative for patients with gastric perforation and poor prognosis who refuse operative procedures, conducted at a hospital in Malang, evaluated using ASA and Boey scores. The study employed a retrospective observational descriptive design. Inclusion criteria were patients with peritonitis due to gastric perforation, diagnosed based on history, physical examination, and supporting tests, with an ASA score of more than equal to 3 and a Boey score of more than equal to 2, who underwent laparotomy, peritoneal drainage, or non-operative management in Malang in 2016. Screening results identified a total of 91 patients with gastric perforation and poor prognosis, with 17 patients receiving non-operative management (19 percent), 8 of whom survived 30 days post-procedure (mortality rate of 52 percent). Among 42 patients who underwent peritoneal drainage (35 percent), 17 survived (mortality rate of 59.52 percent). Among 32 patients who underwent laparotomy (46 percent), 9 survived (mortality rate of 71.87 percent). Mortality rates for laparotomy and peritoneal drainage were higher than for non-operative management (OR of 0.440 and 0.765 for 95 percent CI). This study found that non-operative management resulted in better clinical outcomes for patients with gastric perforation and poor prognosis, making it a consideration in decision-making for patients with poor prognosis, as well as helping to improve resource efficiency in healthcare facilities.

Abstrak:

Perforasi lambung mewakili 25 sampai 30 persen kasus akut abdomen di instalasi gawat darurat, dengan tingkat mortalitas dan morbiditas yang tinggi. Penelitian ini menyajikan manajemen non-operatif sebagai alternatif untuk pasien dengan perforasi lambung dengan prognosis buruk, yang menolak prosedur operatif, di sebuah rumah sakit di Malang, yang dinilai menggunakan skot ASA dan Boey. Penelitian menggunakan desain deskriptif observasional retrospektif. Kriteria inklusi adalah pasien dengan peritonitis akibat perforasi lambung yang ditegakkan berdasarkan anamnesis, pemeriksaan fisik dan penunjang, skor ASA lebih dari sama dengan 3 dan skor Boey lebih dari sama dengan 2, yang menjalani laparotomi, drainase peritoneal, maupun manajemen non-operatif di Malang pada tahun 2016. Hasil skrining menemukan total 91 pasien perforasi lambung dengan prognosis buruk, 17 pasien menjalani manajemen non operatif (19 persen), di mana 8 pasien bertahan hidup dalam 30 hari setelah prosedur (tingkat mortalitas sama dengan 52 persen). Dari 42 pasien yang menjalani drainase peritoneal (35 persen), 17 pasien bertahan hidup (tingkat mortalitas sama dengan 59,52 persen). 32 pasien yang menjalani laparotomi (46 persen), 9 pasien bertahan hidup (tingkat mortalitas sama dengan 71,87 persen). Tingkat mortalitas pada laparotomi dan drainase peritoneal lebih besar daripada manajemen non-operatif (OR sama dengan 0,440 dan 0,765 untuk CI 95 persen). Penelitian ini menemukan bahwa manajemen non-operatif memberikan hasil klinis yang lebih baik pada pasien perforasi lambung dengan prognosis buruk, sehingga dapat menjadi pertimbangan dalam pengambilan keputusan untuk pasien dengan prognosis buruk, serta membantu efisiensi sumber daya di fasilitas kesehatan.

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