Perbandingan skor nyeri pasca operasi antara doppler-guided hemorrhoidal artery ligation and recto anal repair dengan open hemorrhoidectomy pada hemorrhoid internal derajat iii-iv di Siloam Hospitals Lippo Village

Kosasih, Joanna Audricia (2020) Perbandingan skor nyeri pasca operasi antara doppler-guided hemorrhoidal artery ligation and recto anal repair dengan open hemorrhoidectomy pada hemorrhoid internal derajat iii-iv di Siloam Hospitals Lippo Village. Bachelor thesis, Universitas Pelita Harapan.

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Abstract

Latar belakang: Jaringan hemoroid merupakan bagian anatomi normal dari distal rektum dan saluran anal. Namun, kata hemoroid sering kali diartikan sebagai suatu proses patologis. Hemoroid merupakan lesi paling umum yang diderita oleh 5% populasi general. Terdapat banyak metode untuk mengobati hemoroid. Selama ini, metode open hemorrhoidectomy dianggap sebagai gold standard dalam pengobatan hemoroid. Namun, metode ini memiliki skor nyeri pasca operasi yang signifikan, sehingga pasien tidak mau menjalani pengobatan dengan metode ini. Oleh karena itu, ditemukanlah alternatif lain dalam upaya penanganan hemoroid untuk mengurangi nyeri pasca operasi. Salah satunya adalah metode doppler-guided hemorrhoidal artery ligation and recto anal repair (DGHAL-RAR). Tujuan penelitian: Mengetahui perbandingan skor nyeri pasca operasi antara doppler-guided hemorrhoidal artery ligation and recto anal repair dengan open hemorrhoidectomy pada hemoroid internal derajat III-IV di Siloam Hospitals Lippo Village. Metode: Populasi sampel penelitian ini adalah pasien hemoroid internal derajat III- IV di Siloam Hospitals Lippo Village. Data visual analogue score diambil dari rekam medis. Data sampel diperoleh dengan metode consecutive sampling hingga 64 sampel terpenuhi. Data yang diperoleh akan diolah dengan Uji Mann U-Whitney. Hasil : Dari 30 sampel laki-laki, 16 sampel (53,3%) masuk ke dalam kelompok DGHAL-RAR dan 14 lainnya (46,7%) ke dalam kelompok open hemorrhoidectomy. Sedangkan dari 34 sampel perempuan, 16 sampel (47,1%) menjalani tindakan DGHAL-RAR dan 18 lainnya (52,9%) menjalani tindakan open hemorrhoidectomy. Usia rata-rata dalam penelitian ini adalah 41,25 tahun. Jumlah kejadian nyeri pasca operasi pada kelompok DGHAL-RAR dan open hemorrhoidectomy adalah 81,3% dan 96,9%, dengan p value sebesar 0,104. Rata- rata skor Visual Analogue Scale pada kelompok DGHAL-RAR dan open hemorrhoidectomy adalah sebesar 1,97±1,121dan 3,13±1,385 dengan p value sebesar 0,001. Kesimpulan : Penelitian ini menunjukan bahwa perbandingan jumlah kejadian nyeri antara kedua tindakan tidak signifikan secara statistik. Rata-rata skor Visual Analogue Score pada kelompok DGHAL-RAR lebih rendah secara signifikan dibandingkan dengan kelompok open hemorrhoidectomy. Kata kunci: Hemoroid, hemoroid internal, nyeri pasca operasi, DGHAL-RAR, doppler-guided hemorrhoidal artery ligation and recto anal repair, open hemorrhoidectomy / Background: Hemorrhoid tissue is a part of normal anatomy from distal rectum and anal canal. However, the word hemorrhoid is often intended to describe pathological process. Hemorrhoid is a common lesion affecting 5% of the general population. There are lots of method to treat hemorrhoid, and open hemorrhoidectomy has been considered as "gold standard". However, this method has a significant score of post-operative pain which make patients reluctant to undergo this method of treatment. Because of this side effect, another alternative method to treat hemorrhoid has been invented which can reduce the post-operative pain. One of this method is doppler-guided hemorrhoidal artery ligation and recto anal repair (DGHAL-RAR). Aim of study: This study aims to know the comparison of the post-operative pain score between doppler-guided hemorrhoidal artery ligation and recto anal repair compared with open hemorrhoidectomy in internal hemorrhoid grade III-IV patients at Siloam Hospitals Lippo Village. Method: The sample population of this study are internal hemorrhoid grade III-IV patients at Siloam Hospitals Lippo Village. Visual analogue scale data are taken from medical records. Sample data is obtained using consecutive sampling method until 64 samples are met. The data obtained will be processed with Mann U- Whitney test. Results : 16 of 30 male samples (53,3%) underwent DGHAL-RAR and 14 of 30 male samples (46,7%) underwent open hemorrhoidectomy. 16 of 34 female samples (47,1%) underwent DGHAL-RAR and 18 of 34 female samples (52,9%) underwent open hemorrhoidectomy. The mean age of this study was 41,25 years old. Number of postoperative pain occurred in DGHAL-RAR and open hemorroidectomy are 81,3% and 96,9% with p value of 0,104. The average score of Visual Analogue Scale score in DGHAL-RAR and open hemorrhoidectomy are 1,97 and 3,13 with p value of 0,001. Conclusion : This study shows that the comparison of the number of pain in DGHAL-RAR and open hemorrhoidectomy is not statistically significant. The mean score of Visual Analogue Scale Score in DGHAL-RAR group are statistically significant lower than the mean score in open hemorrhoidectomy group. Keywords: Hemorrhoid, internal hemorrhoid, post-operative pain, DGHAL-RAR, hemorrhoidal artery ligation and recto anal repair, open hemorrhoidectomy, Milligan Morgan

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