Oleh
Ali Sibra Mulluzi (ALS)
1. Appendektomi
Penderita dalam posisi supine dan dilakukan anestesi umum, spinal anestesi atau anestesi
lokal
Dilakukan insisi oblique 2 cm medial sias sampai tuberkulum pubikum
Insisi diperdalam sampai tampak aponeurosis MOE (Muskulus Obligus Abdominis Eksternus)
Aponeurosis MOE dibuka secara tajam
Funikulus spermatikus
dibebaskan dari jaringan
sekitarnya dan dikait pita
Preservasi nervus ileoinguinal
dan kantong hernia
diidentifikasi
Isi hernia dimasukan ke dalam
cavum abdomen, kantong
hernia secara tajam dan
tumpul sampai anulus internus
Kantong hernia diligasi setinggi
lemak preperitonium , dilanjutkan
dengan herniotomi
Perdarahan dirawat,
dilanjutkan dengan
hernioplasty dengan
mesh
Luka operasi ditutup lapis
demi lapis
3. Repair Perforasi Gaster
The easiest method of closure consists of placing three sutures of fine silk through the submucosal layer on one side
and extending through the region of the ulcer and out a corresponding distance on the other side of the ulcer
(figure 1). Starting at the top of the ulcer, the sutures are tied very gently to prevent laceration of the friable tissues.
Th e long ends are retained (figure 2). Th e closure is reinforced with omentum by separating the long ends of the
three previously tied sutures and placing a small portion of omentum along the suture line. Th e ends of these
sutures are loosely tied, anchoring the omentum over the site of the ulcer (figure 3).The tissue may be so indurated
that the ulcer cannot be closed successfully, making it necessary to seal the perforation by anchoring omentum
directly over the ulcer In the presence of a perforated gastric ulcer, a small biopsy of the margin of the perforation
is taken because of the possibility of malignancy (figures 4and 5). Th e omentum may be anchored over the
suture line (figure 6). Closure of a gastric ulcer may be reinforced with a layer of interrupted silk serosal sutures since
there is little danger of obstruction.In the presence of perforation of an obvious carcinoma, it is usually safer to
close the perforation, to be followed by resection upon recovery. If the patient’s general condition is good and
the perforation has lasted only a few hours, a gastric resection may be justified. Vagotomy and pyloroplasty or
antrectomy for an early perforated duodenal ulcer in a good-risk patient is preferred by some surgeons
4. Insisi Drainage Phlegmon
DESINFEKSI MENGGUNAKAN BETADINE 10% ATAU HIBITANE ALKOHOL 70% 1:1000 ATAU ALKOHOL 70%,
PADA LAPANGAN OPERASI.
LAPANGAN OPERASI DIPERSEMPIT DENGAN MENGGUNAKAN DUK STERIL ( PENDERITA DIBERI OKSIGENASI
DENGAN MASKER ATAU NASAL PRONGE), DAN LAKUKAN KOMUNIKASI YANG BAIK SUPAYA PENDERITA TIDAK
GELISAH DAN LEBIH KOOPERATIF.
INSISI DEKOMPRESI DENGAN ANESTESI LOKAL ATAU KALAU TERPAKSA (PENDERITA TIDAK KOOPERATIF) DENGAN
NARKOSE.
IRISAN 1 JARI DIBAWAH MANDIBULA SEPANJANG 6CM. ARTERI DAN VENA FASIALIS DILIGASI DI DUA TEMPAT DAN
DIPOTONG DIANTARANYA. GLANDULA SUBMANDIBULA DIRETRAKSI KEARAH KAUDAL SEHINGGA NAMPAK
MUSKULUS MILIHIOID. OTOT INI KEMUDIAN DIPOTONG . DENGAN KLEM BENGKOK JARINGAN SUBLINGUAL
DIBUKA SECARA TUMPUL SEHINGGA NANAH YANG TERKUMPUL DISITU DAPAT MENGALIR KELUAR MELALUI LUKA
INSISI.