Sriwijaya Journal of Surgery

Activated Growth Factors (AGF), an Advanced Platelet-Rich Plasma (PRP) Modality, as a Novel Biological Treatment for Partial Anterior Cruciate Ligament Tears: A Case Report

Rachmat Hidayat — 2024-11-21

Introduction: Partial anterior cruciate ligament (ACL) ruptures present a complex clinical challenge. Traditional treatment options, including conservative management and surgical reconstruction, often yield unpredictable outcomes and extended recovery periods. This case report explores the potential of activated growth factors (AGF), an advanced platelet-rich plasma (PRP) modality, as a novel biological treatment strategy for partial ACL tears.

Case presentation: A 39-year-old male presented with right knee pain and instability following a twisting injury sustained during exercise. Magnetic resonance imaging (MRI) confirmed a partial tear of the anteromedial bundle of the ACL. The patient was treated with a series of three intra-articular injections of AGF, administered at weekly intervals. The AGF was prepared using a proprietary protocol aimed at optimizing growth factor concentration and release. The patient's progress was meticulously monitored through clinical evaluations and functional assessments at 3 and 6 months post-treatment.

Conclusion: This case suggests that AGF may offer a promising alternative for the treatment of partial ACL tears, potentially facilitating accelerated healing and improved clinical outcomes. Further research, including controlled trials, is warranted to validate these findings and establish the efficacy and safety of AGF in a larger patient population.

Spinal Accessory Nerve to Suprascapular Nerve Neurotization for Brachial Plexus Injury: A Retrospective Study

Seti Aji Hadinoto — 2024-12-10

Introduction: Brachial plexus injuries (BPIs) often lead to significant functional impairment of the upper extremity, particularly affecting shoulder abduction and external rotation. Spinal accessory nerve (SAN) to suprascapular nerve (SSN) neurotization is a surgical technique employed to restore shoulder function in these patients. This study aimed to evaluate the outcomes of this procedure in a series of patients with BPI.

Methods: A retrospective observational case series study was conducted, including patients who underwent SAN to SSN neurotization for BPI at a single institution between January 2019 and December 2021. Patient demographics, injury characteristics, surgical details, and functional outcomes were collected from medical records. Functional outcomes were assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) score preoperatively and at the final follow-up.

Results: A total of 8 patients were included in the study. The mean age was 25.7 years (range, 12-39 years), with a majority being male (55.6%). The most common cause of BPI was motor vehicle accidents (90%). The mean DASH score improved significantly from 72.5 preoperatively to 37.5 postoperatively (p<0.05).

Conclusion: SAN to SSN neurotization appears to be a safe and effective technique for improving shoulder function in patients with BPI. This study demonstrated significant improvements in DASH scores following the procedure. However, further research with larger sample sizes and longer follow-up periods is needed to confirm these findings and evaluate the long-term outcomes of this technique.

Predicting Burn Patient Mortality: A Comparative Analysis of the BOBI and R-Baux Scoring Systems

Abda Arif — 2024-12-23

Introduction: Burns represents a significant global health challenge, causing considerable morbidity and mortality. Accurate prognostication is crucial for optimal burn care management. This study compared the accuracy of the BOBI and R-Baux scores in predicting mortality among burn patients.

Methods: This retrospective study analyzed data from 46 burn patients treated at Dr. Mohammad Hoesin General Hospital Palembang. Patient demographics, burn characteristics, and mortality outcomes were recorded. BOBI and R-Baux scores were calculated for each patient. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Youden Index were determined for both scores. Agreement between the scores was assessed using the Kappa statistic. Statistical analysis was performed using SPSS v25.

Results: The majority of patients were male (76.1%) and under 50 years old (84.8%). Fire burns (63%) and superficial-mid dermal injuries (32.6%) were most prevalent. The BOBI score demonstrated fair accuracy (sensitivity: 84.6%, specificity: 63.6%, PPV: 0.478, NPV: 0.913, Youden Index: 0.480). The R-Baux score showed lower sensitivity (76.9%) but higher specificity (78.8%) (PPV: 0.588, NPV: 0.896, Youden Index: 0.560). The Kappa test indicated good agreement between the two scores (κ = 0.783, p = 0.000).

Conclusion: Both BOBI and R-Baux scores can be used to predict mortality in burn patients. The BOBI score demonstrated higher sensitivity, while the R-Baux score exhibited higher specificity. The choice of scoring system may depend on the specific clinical context and the relative importance of sensitivity and specificity.

An Unusual Presentation of Pancreatic Neuroendocrine Carcinoma in a Young Woman: A Case Report

Iman Hakim Wicaksana — 2025-01-17

Introduction: Pancreatic neuroendocrine tumors (PNETs) are rare neoplasms arising from the endocrine cells of the pancreas. They are typically diagnosed in older adults, with a peak incidence between 70 and 74 years. PNETs in young adults are uncommon and often present with non-specific symptoms, leading to delays in diagnosis and treatment.

Case presentation: We report the case of a 22-year-old woman who presented with a large, non-functional PNET located in the tail of the pancreas. The patient initially complained of vague abdominal discomfort, nausea, and vomiting. Imaging studies revealed a large, heterogeneous mass in the left upper quadrant. The patient underwent a distal pancreatectomy, and histopathological examination confirmed the diagnosis of a poorly differentiated pancreatic neuroendocrine carcinoma.

Conclusion: This case highlights the challenges in diagnosing PNETs in young adults. Clinicians should maintain a high index of suspicion for PNETs in young patients presenting with abdominal symptoms, even in the absence of classic hormonal syndromes. Early diagnosis and surgical intervention are crucial for improving outcomes in these patients.

Predicting Postoperative Mortality in Head Injury Patients: Evaluating the Accuracy of Rotterdam Score

Fadhli Aufar Kasyfi — 2025-01-20

Introduction: Head injury remains a leading cause of mortality and morbidity globally, necessitating accurate prognostic tools to guide clinical decision-making and inform patient outcomes. Rotterdam Score, a computed tomography (CT)-based scoring system, has shown promise in predicting mortality in head injury patients. This study aimed to evaluate the accuracy of the Rotterdam Score in predicting postoperative mortality in head injury patients undergoing surgery.

Methods: A retrospective analysis was conducted on 56 head injury patients who underwent surgery at Dr. Mohammad Hoesin General Hospital, Palembang, between December 2023 and November 2024. Patient demographics, clinical characteristics, and CT scan findings were collected. Rotterdam Score was calculated for each patient, and its accuracy in predicting postoperative mortality was assessed using receiver operating characteristic (ROC) curve analysis.

Results: The study cohort comprised 37 (66.1%) males and 19 (33.9%) females, with a mean age of 31.8 ± 21.6 years. Mild head injury was the most common Glasgow Coma Scale (GCS) classification (42.9%). The overall mortality rate was 17.8%. ROC curve analysis revealed an area under the curve (AUC) of 0.953 for the Rotterdam Score, with an optimal cut-off value of 4.5. Rotterdam Score demonstrated a sensitivity of 80%, specificity of 97.8%, positive predictive value (PPV) of 88.8%, and negative predictive value (NPV) of 95.7% in predicting postoperative mortality.

Conclusion: The Rotterdam Score is a highly accurate predictor of postoperative mortality in head injury patients undergoing surgery. Its CT-based assessment allows for rapid and objective prognostication, aiding clinicians in risk stratification and treatment planning. Further research with larger and more diverse populations is warranted to validate these findings and establish the generalizability of Rotterdam Score across different healthcare settings.

Can Pediatric Appendicitis Risk Calculator Replace Pediatric Appendicitis Score? A Comparative Study in Diagnosing Acute Appendicitis in Children

Egha — 2025-01-24

Introduction: Acute appendicitis is the most common cause of operative emergencies in children, necessitating prompt and accurate diagnosis to minimize complications. Clinical scoring systems like the pediatric appendicitis score (PAS) and the more recent pediatric appendicitis risk calculator (pARC) have been developed to aid in diagnosis. This study aimed to compare the accuracy of pARC and PAS in diagnosing acute appendicitis in children.

Methods: This retrospective study analyzed the medical records of pediatric patients (age: 5-18 years) admitted to Dr. Mohammad Hoesin General Hospital Palembang with suspected acute appendicitis between October 2022 and October 2024. pARC and PAS scores were calculated for each patient, and their diagnostic accuracy was compared using histopathology results as the gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and kappa statistics were calculated.

Results: A total of 36 patients with histopathologically confirmed acute appendicitis were included. The pARC score demonstrated a sensitivity of 82.8%, specificity of 100%, PPV of 96.6%, and NPV of 100%. The PAS score showed a sensitivity of 80.0%, specificity of 100%, PPV of 96.5%, and NPV of 100%. The kappa statistic indicated good agreement between pARC and PAS (0.861).

Conclusion: Both pARC and PAS demonstrated high accuracy in diagnosing acute appendicitis in children. While pARC showed slightly higher sensitivity and PPV, the difference was not statistically significant. These findings suggest that pARC could potentially replace PAS as the preferred diagnostic tool, but further research with larger sample sizes is needed to confirm these results.

Chemotherapy and Quality of Life in Breast Cancer Patients: A Case-Series Study in Palembang, Indonesia

Eka Satyani Belina — 2025-01-30

Introduction: Breast cancer is a prevalent malignancy affecting women worldwide, and its treatment, particularly chemotherapy, can significantly impact patients' quality of life (QoL). This study aimed to assess the QoL of breast cancer patients undergoing chemotherapy in Palembang, Indonesia, and to identify factors associated with their QoL.

Methods: A cross-sectional study was conducted at the Oncology Unit of Dr. Mohammad Hoesin General Hospital in Palembang, Indonesia, from December 2024 to January 2025. A total of 150 breast cancer patients who met the inclusion criteria were enrolled in the study. Data were collected through medical records and the Functional Assessment of Cancer Therapy - Breast (FACT-B) questionnaire. The FACT-B assesses QoL in five domains: physical, social/family, emotional, functional, and breast cancer-specific concerns. Descriptive statistics, Spearman's correlation, and logistic regression were used to analyze the data.

Results: The majority of the patients were aged 40-60 years (70%), had low educational levels (41.3%), were married (83.3%), had locally advanced disease (44%), and had completed chemotherapy (41.3%). The mean FACT-B total score was 76.8. A significant negative correlation was found between the intensity of chemotherapy and QoL (r = -0.306, p = 0.000). Logistic regression analysis revealed that patients who had completed chemotherapy had a significantly lower QoL than those who had not undergone chemotherapy (OR = 0.30, 95% CI = 0.15-0.60, p = 0.001).

Conclusion: Chemotherapy significantly impacts the QoL of breast cancer patients in Palembang, Indonesia. Patients who have completed chemotherapy have a lower QoL than those who have not undergone chemotherapy. These findings highlight the importance of providing comprehensive supportive care to breast cancer patients undergoing chemotherapy to improve their QoL.

Digestive Surgery Patterns in Rural Indonesia: Insights from Lampung Province

Satrio Sarwo Trengginas — 2025-04-22

Introduction Digestive surgical conditions represent a significant portion of the global surgical burden, particularly impacting low- and middle-income countries (LMICs). However, epidemiological data detailing the specific patterns of digestive surgery in rural Indonesian healthcare settings remain scarce. Understanding these patterns is crucial for effective healthcare planning and resource allocation.

Methods: A descriptive observational study was conducted retrospectively across three type D hospitals situated in Central and South Lampung, Indonesia. Data were collected from surgical records and patient registers spanning the period from January 2024 to February 2025. All patients undergoing digestive surgical procedures during this timeframe, for whom complete data were available, were included.

Results: A total of 773 patients underwent digestive surgery during the study period. The patient cohort showed a male predominance (65.20%). The three most frequent surgical conditions encountered were hernia (n=274, 35.45%), hemorrhoids (n=148, 19.15%), and appendicitis (n=123, 15.91%). Inguinal hernia (82%) treated predominantly with herniorrhaphy (89%) was the leading hernia type, peaking in the 51–60 year age group. Internal hemorrhoids (86%), primarily grade III (45%), were most common, with a peak incidence in the 41–50 year age group. Acute appendicitis (92%) was more frequent in females (53.66%), with a mean age of approximately 27 years.

Conclusion: Hernia, hemorrhoids, and appendicitis constitute the primary digestive surgical workload in the surveyed rural type D hospitals in Lampung province. These findings underscore the specific surgical needs within these limited-resource settings and highlight a critical need for comprehensive, nationwide studies encompassing diverse hospital types and including non-operative cases to inform Indonesian health policy.

Predicting Mortality in Gastric Perforation: A Comparative Analysis of Boey Score and Mannheim Peritonitis Index Accuracy in an Indonesian Tertiary Hospital

Bobi Wijaya — 2025-05-05

Introduction: Peptic ulcer perforation (PUP), often leading to gastric perforation, represents a significant surgical emergency demanding rapid intervention. Effective risk stratification using prognostic scoring systems is crucial for optimizing patient management and improving outcomes. This study aimed to evaluate and compare the predictive performance of the Mannheim Peritonitis Index (MPI) and the Boey Score in estimating in-hospital mortality risk among patients presenting with gastric perforation at a tertiary hospital in Indonesia.

Methods: A retrospective descriptive study employing an accuracy testing design was conducted. Data were collected from the medical records of 31 adult patients (≥18 years) who underwent exploratory laparotomy for non-traumatic gastric perforation at Dr. Mohammad Hoesin General Hospital Palembang, between January 2023 and December 2024. Patients with incomplete medical records were excluded. Boey Scores and MPI scores were calculated for each patient based on predefined criteria. The primary outcome measured was in-hospital mortality. Statistical analysis included descriptive statistics, calculation of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and Receiver Operating Characteristic (ROC)¹ curve analysis to determine optimal cutoff values.

Results: The median age was 62 years, with a male predominance (87.1%). Most patients presented late (>24 hours post-perforation, 90.3%) and had organ dysfunction (80.6%). Preoperative shock was present in 48.4%. The optimal cutoff for MPI predicting mortality was ≥22, yielding a sensitivity of 87.5% and specificity of 40.0%. The optimal Boey Score cutoff was ≥2, with a sensitivity of 75.0% and specificity of 53.3%. Comparing MPI (cutoff ≥22) against Boey Score (cutoff ≥2) as a reference, the MPI demonstrated an accuracy of 74.19%, sensitivity of 73.91%, specificity of 75.00%, PPV of 89.47%, and NPV of 50.00%.

Conclusion: Both the Boey Score and MPI showed moderate predictive performance for in-hospital mortality in patients with gastric perforation in this cohort. MPI (cutoff ≥22) demonstrated higher sensitivity for identifying high-risk patients compared to the Boey Score (cutoff ≥2), although with lower specificity regarding mortality itself. MPI appears advantageous for identifying high-risk individuals, while the simpler Boey Score remains useful for rapid initial assessment.

Total Elbow Arthroplasty as a Viable Reconstruction Option for Proximal Ulna Giant Cell Tumor: Case Report

Mujaddid Idulhaq — 2025-05-06

Introduction: Giant cell tumor (GCT) of bone is a relatively common primary bone tumor, typically benign but known for local aggressiveness and potential for recurrence. It commonly affects the epiphyseal regions of long bones, particularly around the knee. Occurrence in the proximal ulna is rare, accounting for less than 1% of skeletal tumors, posing significant treatment challenges due to the complex elbow anatomy. Treatment aims for complete tumor removal, preservation of function, and prevention of recurrence, with options ranging from curettage to wide resection. Reconstruction after resection, especially involving the joint, is complex.

Case presentation: We report the case of a 39-year-old female presenting with a painful swelling in her right elbow three months after a fall. Clinical examination revealed swelling, tenderness, and limited range of motion. Radiographs and MRI showed an expansile lytic lesion in the proximal ulna, suggestive of GCT. The patient underwent wide resection of the tumor followed by reconstruction using total elbow arthroplasty (TEA). Histopathology confirmed the diagnosis of GCT.

Conclusion: At 8-month follow-up, the patient demonstrated excellent functional recovery with a range of motion from 0° extension to 150° flexion, a DASH score of 6.7, and an MSTS score of 26, with no signs of local recurrence. This case illustrates that wide resection combined with TEA is a viable and effective treatment strategy for GCT of the proximal ulna, offering good functional outcomes and local tumor control.

Impact of Prolonged Cardiopulmonary Bypass and Aortic Cross-Clamp Time on Postoperative Ventilator Dependency Following Mitral Valve Replacement

Aswin Nugraha — 2025-05-07

Introduction: Mitral valve replacement (MVR) is a common procedure for severe mitral valve disease. Prolonged cardiopulmonary bypass (CPB) time and aortic cross-clamp (AOX) time during cardiac surgery are known to be associated with adverse postoperative outcomes, including prolonged mechanical ventilation. Understanding the predictive value of these intraoperative times specifically for ventilator dependency after MVR is crucial for risk stratification and patient management. This study aimed to determine the accuracy of CPB time and AOX time as predictors of postoperative ventilator duration in patients undergoing MVR at a tertiary referral hospital in Palembang, Indonesia.

Methods: A retrospective cohort study was conducted using medical records of patients aged ≥ 18 years who underwent MVR between January 2022 and December 2024 at RSUP Dr. Mohammad Hoesin Palembang. Data from 79 patients meeting the inclusion criteria were analyzed. The primary independent variables were CPB time and AOX time (categorized using a 90-minute cut-off). The primary outcome was prolonged mechanical ventilation (defined as >24 hours). Secondary outcomes included ICU length of stay (>4 days) and in-hospital mortality. Statistical analysis involved Chi-square tests and multivariate logistic regression.

Results: Prolonged CPB time (≥90 minutes) was observed in 62% of patients, and prolonged AOX time (≥90 minutes) in 45.6%. Both prolonged AOX time (OR 15.167, p=0.01) and prolonged CPB time (OR 8.88, p=0.01) were significantly associated with mechanical ventilation >24 hours. Multivariate analysis confirmed both AOX time (Adjusted OR 8.741, p=0.049) and CPB time (Adjusted OR 5.163, p=0.027) as independent predictors for prolonged ventilation. Significant associations were also found between prolonged AOX/CPB times and ICU stay >4 days (p=0.03 for both). No significant association was found between CPB/AOX times and in-hospital mortality (p=0.968 and p=0.206, respectively).

Conclusion: Prolonged CPB time and AOX time are significant independent predictors of postoperative ventilator dependency exceeding 24 hours following MVR in this patient cohort. Minimizing these intraoperative durations may reduce the burden of prolonged mechanical ventilation.

Beyond Clinical Intuition: Quantitative Mortality Prediction in Blunt Thoracic Trauma using the Thoracic Trauma Severity Score (TTSS)

Harief Seamaladi — 2025-05-12

Introduction: Blunt thoracic trauma is a leading cause of significant morbidity and mortality, particularly in younger populations. Accurate and early prediction of mortality is crucial for guiding clinical management and resource allocation. This study aimed to move beyond subjective clinical assessment by evaluating the accuracy of the Thoracic Trauma Severity Score (TTSS) as an objective, quantitative tool for predicting in-hospital mortality in patients with blunt thoracic trauma in a specific regional trauma center.

Methods: A retrospective cohort study was conducted at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia. Data from 38 patients admitted with blunt thoracic trauma between January 2023 and January 2025 were analyzed. The TTSS was calculated for each patient based on five parameters: age, number of rib fractures, presence of bilateral rib fractures, extent of pulmonary contusion (assessed by chest X-ray), and the PaO₂/FiO₂ ratio (from arterial blood gas analysis). The primary outcome was in-hospital mortality. Receiver Operating Characteristic (ROC) curve analysis was used to determine the predictive accuracy of the TTSS, including the Area Under the Curve (AUC), sensitivity, specificity, and optimal cut-off value. Bivariate analysis using the chi-square test was performed.

Results: Of the 38 patients, 76.3% (n=29) were male. The mortality rate was 15.8% (n=6). The ROC curve analysis for TTSS in predicting mortality yielded an AUC of 0.727 (95% CI: 0.447–1.000; p = 0.082). At an optimal cut-off value of 10.5, the TTSS demonstrated a sensitivity of 66.6% and a specificity of 71.8% for mortality prediction. Patients with TTSS >7 had a significantly higher proportion of mortality (83% of deaths occurred in this group) compared to those with TTSS $\leq$7.

Conclusion: The Thoracic Trauma Severity Score (TTSS) showed fair predictive accuracy for in-hospital mortality in patients with blunt thoracic trauma in this study setting. While demonstrating reasonable sensitivity at a cut-off of 10.5, its specificity was also moderate. The TTSS can serve as a useful quantitative adjunct to clinical judgment, aiding in the early identification of patients at higher risk, though its limitations, particularly the modest specificity and non-significant p-value for AUC in this cohort, warrant cautious interpretation and highlight the need for further validation in larger, multicenter studies.