Introduction. Surgical repositioning of biliary drainage to the intestine (jejunum) through an artificial fistula (portoenterostomy) following surgical removal of extrahepatic residual biliary duct in biliary atresia, which is first proposed by Kasai has never been evaluated in our center. Thus, we run a study aimed to find out the success rate. Method. We run a cohort study retrospectively enrolled subjects with biliary atresia consecutively. A review of histopathology was carried out, and focused on degree of fibrosis as well as cirrhosis. Obtained data were subjected to statistical analysis using Fischer test and logistic regression. Results. Out of 15 subjects enrolled in the study, we found success management in five subjects based on three months of icteric free period. Using Fischer test, we found a significant correlation (p = 0.04) between degree of fibrosis and outcomes in 1-year period with relative risk of 4 (CI 95% 1.5-10.65). Conclusion. Affecting factors in success rate of portoenterostomy remains unclear; degree of fibrosis might be the one. Different center reports different outcome as the histopathology characteristics varies in different center.

Introduction.Intestinal obstruction has been shown to induce bacterial translocation and in turn, would be associated with an increased risk of sepsis. Such a condition would be affecting the achievement of peristaltic and ultimately increased morbidity and mortality. In addition, nosocomial infections that threaten neonates cause sepsis also will affect the achievement of a peristaltic. Thus, the aim of this study was to investigate the relationship between sepsis with timing achievement of peristaltic postoperatively. Method. This is a cross-sectional study with data obtained from medical records of patients with duodenal obstruction without congenital abnormalities (gastroschisis, omphalocele, and another intestinal atresia) that underwent operations in RSCM during the period of January 2010 to July 2016. Subjects were grouped into sepsis and without sepsis. The association between sepsis and timing achievement of peristaltic, and confounding variables (gestational age, birth weight, congenital abnormalities, conditions of hypoxia and electrolyte imbalance) were analyzed. Data analyzed using univariate, bivariate (Mann Whitney, Chi-Square or Fischer) and multivariate (linear regression) with the significance of <0.05. Results. The study enrolled a total of 31 subjects. Period to achieve peristaltic (median value) was 12.5 days in subjects with sepsis and 5 days in those without sepsis. Bivariate analysis between timing achievement of peristaltic were sepsis (p <0.0001), gestational age (p = 0.004) and hypoxic conditions (p = 0.02). The multivariate analysis showed an association between sepsis and timing achievement of peristaltic (p = 0.011, R 2 = 35.8%). Conclusion. In this study, sepsis was a major factor affecting the achievement of a peristaltic. The time difference to achieved peristaltic between sepsis and without sepsis was significance. Thus, it is necessary to control and prevent sepsis preoperatively and postoperatively that in turn, reducing morbidity and mortality.

Introduction.Delayed hospital presentation is a characteristic we found in management of intussusception in our institution. However, with this delayed, surgical intervention is the only option in treatment. Thus, duration of onset is an answered problem. We run a study aimed to find out whether duration is a predictor of bowel resection in management of intussusception. Method. We run retrospective study on idiopathic intussusception managed in period of January 2008 to December 2015 in Cipto Mangunkusumo Hospital, Jakarta. Those other than idiopathic and insufficient data were excluded. Period of onset, signs and symptoms, ultrasound and surgical treatment as well as intraoperative findings were set as the variables and subjected to statistical analysis using χ2 or Fisher's exact test and t-test; significance is met if p value of <0.05. Analysis to find out cut-off point using receiver operating characteristic curve were carried out. Results. There were seventy-three subjects diagnosed as intussusception enrolled in the study. Median age was 7 months (3-48 month). Median period of onset to definitive treatment was 81 hours (15-256 hours). Bloody stools found in 90.4% instead of classic triad (28.7%). All subjects underwent surgical procedure, and out of 73 subjects, 61.6% underwent resection. We found clinical duration was associated to bowel resection (p 0.004) and area under curve 73.7% (p 0.001). The cut-off point as prediction of bowel resection was 78.5 hours with sensitivity of 67.9% and specificity of 71.1%. Conclusion. Surgical intervention is recommended for management of intussusception in those with clinical duration of more than 78.5 hours, instead of non-surgical reduction.