Appendectomy in BPJS
Appendectomy in BPJS
Appendectomy in BPJS
• US: 11 cases per 10,000 population annually. ♂ >, perforated cases have no
gender predilection. In a lifetime, 8.6% of ♂ and 6.7% of ♀ can be expected to
develop acute appendicitis. Young age is a risk factor; nearly 70% < 30 years. The
highest incidence ♂ 10-14yo vs ♀ 15-19yo. Perforation 19% of cases of
acute appendicitis, bimodal distribution significantly >> among patients < 5
and > 65 years.1
• South Korea: overall incidences of appendicitis, total appendectomy, and
perforated appendectomy were 22.71, 13.56, and 2.91 per 10 000 population per
year, respectively. Appendectomy 59.70% of inpatients with appendicitis. The
incidence of appendicitis and appendectomy showed clear seasonality, with a
peak in summer. Lifetime risk of appendicitis ♂ (16.33%) vs ♀ (16.34%), and
the lifetime risk of appendectomy ♂ (9.89%) vs ♀ (9.61%).2
1. Addiss DG, Shaer N, Fowler BS, et al. e epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990;132:910–925.
2. Lee JH, Park YS, Choi JS. The Epidemiology of Appendicitis and Appendectomy in South Korea: National Registry Data. J Epidemiol. 2010; 20(2): 97–105.
EPIDEMIOLOGY
DATA APPENDICITIS RSUD TARAKAN, KALTARA
Appendicitis Akut Appendicitis Kronik Appendicitis Perforasi
400
2020 sd
2015 2016 2017 2018 2019 Juni
Appendicitis Akut
350 356 215 246 217 257 85
Appendicitis Kronik 0 0 4 9 8 4
300
Appendicitis Perforasi 14 108 150 12 58 27
TOTAL
250 370 323 400 238 323 116
200
150
100
50
0
2015 2016 2017 2018 2019 2020 sd Juni
HISTORY
• Claudius Amyand (December 6, 1735): St. George's Hospital
in London, perforated appendix within the inguinal hernial
sac of an 11-year-old boy by a pin the boy had swallowed,
Hanvil Andersen recovery & discharged a month later.
• Lawson Tait (1880), London: transabdominal appendectomy
for gangrenous appendix.
• Charles McBurney (1889), New York City: presentation &
pathogenesis of appendicitis accurately early
appendectomy was the best treatment to avoid perforation
& peritonitis.
• Autoappendectomies: Evan O'Neill Kane (1921), but the
operation was completed by his assistants. Leonid Rogozov
(1961), who had to perform the operation on himself as he
was the only doctor on a remote Antarctic base.
• Kurt Semm (September 13, 1980): the first laparoscopic
appendectomy.
APPENDICITIS & COVID19
Zhang JJ, Dong X, Cao YY, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020.
APPENDICITIS & COVID19
• Basal pneumonia with pleural effusion may explain pain and
discomfort in the upper abdomen
• SARS-CoV-2 have proteins that readily bind to the cell receptor
angiotensin-converting enzyme 2 (ACE2)
• GI epithelial cells ↑ ACE2 receptors (30 %, vs 1 % in the lungs)
• Identified the SARS-CoV-2 RNA in anal/rectal swabs and stool
specimens of Covid-19 patients, even after the clearance of the
virus in the upper respiratory tract
• Possible transmission route through the faecal contents???
• Hospitalisation >>> patients with GI symptoms & poorer
prognosis
Pan L, Mu M, Ren HG et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional,
multicenter study. Am J Gastroenterol 20.3.2020.
APPENDECTOMY PROCEDURE
OPEN VS LAPAROSCOPIC
McCall JL, Sharples K, Jadallah F. Systemic review of randomized controlled trials comparing laparoscopic with open appendicectomy: a
metaanalysis. J Am Coll Surg . 1998; 186:545–553; and Sauerland S, Lefering R, Neugebaur EA. Laparoscopic versus open surgery for suspected
appendicitis. Cochrane Database Syst Rev . 2004;4:CD001546.
OPEN APPENDECTOMY
• Preoperative Preparation
• IV fluids, VS closely monitored. Dehydration Foley catheter (urine output
monitoring).
• Severe electrolyte abnormalities (>> in cases of perforation) corrected prior
to the induction of anesthesia.
• Prophylaxis: a single dose of antibiotics, typically a 2nd gen cephalosporin.
• Incision: 1. McBurney's incision (grid iron), 2. Lanz incision, 3. Rutherford
Morison incision, 4. Paramedian incision
• Reexamined after the induction of anesthesia deep palpation: a mass +
representing the infamed appendix incision can be centered at that
location. Mass - incision should be centered over McBurney’s point
• Important not to make the incision too medial (opens into the anterior rectus
sheath) or too lateral (lateral to the abdominal cavity).
OPEN APPENDECTOMY
• Antegrade
Zinner MJ, Ashley SW, Hines OJ. Maingot’s Abdominal Operation. Mc Graw Hill 13 ed. 2019
Haile T. Debas. Gastrointestinal surgery : pathophysiology and management. Springer. 2003
OPEN APPENDECTOMY
• Mesoappendix
clamped, ligated with
3-0 silk suture, and
divided.
SOFSILK
Zinner MJ, Ashley SW, Hines OJ. Maingot’s Abdominal Operation. Mc Graw Hill 13 ed. 2019
Haile T. Debas. Gastrointestinal surgery : pathophysiology and management. Springer. 2003
OPEN APPENDECTOMY
Zinner MJ, Ashley SW, Hines OJ. Maingot’s Abdominal Operation. Mc Graw Hill 13 ed. 2019
Haile T. Debas. Gastrointestinal surgery : pathophysiology and management. Springer. 2003 CHROMIC GUT
OPEN APPENDECTOMY
• If stump inversion is
chosen seromuscular
purse-string 3-0 silk
suture is placed in the
cecum around the
appendiceal base
SOFSILK
Zinner MJ, Ashley SW, Hines OJ. Maingot’s Abdominal Operation. Mc Graw Hill 13 ed. 2019
Haile T. Debas. Gastrointestinal surgery : pathophysiology and management. Springer. 2003
OPEN APPENDECTOMY
• Peritoneum: continuous 0
absorbable suture.
• Internal & external oblique
muscles: continuous 0
absorbable suture.
• Scarpa’s fascia: interrupted
absorbable sutures
• Skin: subcuticular
absorbable suture.
POLYSORB
Zinner MJ, Ashley SW, Hines OJ. Maingot’s Abdominal Operation. Mc Graw Hill 13 ed. 2019
Haile T. Debas. Gastrointestinal surgery : pathophysiology and management. Springer. 2003
OPEN APPENDECTOMY
• Retrograde
POLYSORB
IDEAL SUTURE:
MORE FILAMENTS
FINER FILAMENTS
EXCELLENCE COATING
MULTIFILAMENT
ABSORBABLE SUTURES
OPEN APPENDECTOMY
• Postoperative Care
• Similar after laparoscopic and open approaches patients with
nonperforated appendicitis typically require a 24- to 48-hour hospital stay.
• Patients can be started on a clear liquid diet immediately, which can be
advanced to their preoperative baseline diet as tolerated.
• No postoperative antibiotics are required for nonperforated appendicitis.
• Patients can be discharged when they tolerate a regular diet and pain is
controlled on oral agents.
LAPAROSCOPIC APPENDECTOMY
Zinner MJ, Ashley SW, Hines OJ. Maingot’s Abdominal Operation. Mc Graw Hill 13 ed. 2019
Haile T. Debas. Gastrointestinal surgery : pathophysiology and management. Springer. 2003
LAPAROSCOPIC APPENDECTOMY
Lasso Technique
Zinner MJ, Ashley SW, Hines OJ. Maingot’s Abdominal Operation. Mc Graw Hill 13 ed. 2019
Haile T. Debas. Gastrointestinal surgery : pathophysiology and management. Springer. 2003
LAPAROSCOPIC APPENDECTOMY
Endobag
Zinner MJ, Ashley SW, Hines OJ. Maingot’s Abdominal Operation. Mc Graw Hill 13 ed. 2019
Haile T. Debas. Gastrointestinal surgery : pathophysiology and management. Springer. 2003
LAPAROSCOPIC APPENDECTOMY
K35.8 47.01
K35.2 54.11
47.09
K35.8
SIMULASI KLAIM BPJS RS TIPE B