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Sigit Adi Prasetyo, Ignatius Riwanto

FAKTOR-FAKTOR YANG MEMPENGARUHI NYERI PASCA OPERASI HEMOROID INTERNA SETELAH DILAKUKAN HEMORRHOID ARTERI LIGATION AND RECTOANAL REPAIR (DGHAL-RAR)

 

ABSTRAK

 

Latar belakang: DGHAL-RAR adalah modalitas baru untuk pengobatan hemoroid interna derajat II hingga IV. Hal ini dikembangkan untuk mengurangi rasa sakit setelah operasi yang sebagian besar ditemukan di hemoroidektomi tradisional bahkan di hemoroidopeksi stappler. Namun, dalam praktek klinis beberapa pasien DGHAL-RAR masih mengeluh nyeri dari sedang sampai berat. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang mempengaruhi rasa sakit pasca operasi setelah DGHAL-RAR pada hemoroid interna. Metode: Sebanyak 61 pasien hemoroid interna derajat II-IV menjalani DGHAL-RAR di Rumah Sakit St Elizabeth, Semarang Indonesia, periode Agustus 2012 – Maret 2014 dianalisis secara prospektif. Usia, jenis kelamin, derajat hemoroid, menghilangkan trombus internal maupun eksternal, fisura anus, eksisi anal papilla hipertrofi, eksisi tag kulit, luka gores anal karena prosedur, dianalisis untuk mengetahui hubungannya dengan nyeri pasca operasi dalam 24 jam, 48 jam dan 7 hari pasca operasi. VAS untuk nyeri (0–10) digunakan untuk menilai tingkat rasa nyeri. Metode Mann-Whitney digunakan untuk analisis univariat, sementara Kruskal-Wallis dan metode Median digunakan untuk analisis multivariat.

Hasil: Setelah variabel dilakukan analisis multivariat, faktor   faktor yang signifikan terhadap nyeri pasca operasi di 24 jam yaitu menghilangkan trombosis internal, eksisi anal papilla hipertrofi dan laserasi anal, pada 48 jam menghilangkan trombosis eksternal, eksisi anal papilla hipertrofi dan laserasi anal dan pada hari ke 7 terdapat faktor-faktor yang sama dengan pengamatan setelah 24 jam pasca operasi.

ABSTRACT

 

Background: DGHAL-RAR is new modality for grade II-IV internal hemorrhoid treatment. It is developed to reduce post-operative pain that mostly found in traditional hemorrhoidectomy even in Stappler hemorrhoidopexy. However, in clinical practice some patients are complaint of moderate until severe pain. This study is intended to know factors affecting the post-operative pain after DGHAL-RAR of internal hemorrhoid.

Methods: A series of 61 grade II-IV internal hemorrhoid patients, underwent DGHAL-RAR in St Elizabeth Hospital, Semarang Indonesia, period of August 2012 – March 2014 were analyzed prospectively. Age, sex, grade, removing of thrombus  either internal or external, anal fissure, removing of hypertrophic anal papilla, removing skin tag, anal laceration due to procedure, were analyzed to know it relation with post operative pain in 24 hours, 48 hours and 7 days post-operatively. VAS for pain (0–10) were used to assess the degree of pain. Mann-Whitney method was used for univariate analysis, while Kruskal-Wallis and Median method were used for multivariate analysis.

Results: After multivariate analysis variables that significantly influence post operative pain on 24 hours were removing of internal thrombosis, removing of anal papilla hypertrophy and anal laceration, on 48 hours were removing of external thrombosis, removing of anal papilla hypertrophy and anal laceration and  on 7 days were the same with on 24 hours.

Conclusion: Factors that affecting post-operative pain after DGHAL-RAR  for grade II-IV internal hemorrhoid were removing of both internal and external thrombosis, removing of anal papilla hypertrophy and anal laceration due to DGHAL-RAR procedure.

Keywords: Internal hemorrhoid, Hemorrhoid artery ligation and recto-anal repair, thrombosis, anal papilla hypertrophy, anal laceration.

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