Urgensi Appendectomy Profilaksis pada Personel Dengan Penugasan Jangka Panjang dan di Tempat Tanpa Fasilitas Kesehatan Memadai
DOI:
https://doi.org/10.57235/jetish.v5i2.9239Keywords:
apendisitis akut, appendektomi profilaksis, penugasan jangka panjang, austere environment, mission readinessAbstract
Apendisitis akut merupakan salah satu kegawatdaruratan bedah yang dapat terjadi selama penugasan jangka panjang, terutama pada personel yang ditempatkan di wilayah terpencil, lingkungan austere, kapal, pulau terluar, atau daerah operasi dengan keterbatasan fasilitas kesehatan dan evakuasi. Kondisi tersebut berpotensi mengganggu keselamatan personel sekaligus menurunkan mission readiness. Penelitian ini dilakukan karena belum terdapat pendekatan yang memadai dalam menentukan urgensi prophylactic appendectomy berdasarkan integrasi risiko apendisitis, durasi penugasan, keterbatasan medical support, dan dampak operasional. Penelitian bertujuan menganalisis urgensi appendektomi profilaksis pada personel dengan penugasan jangka panjang dan akses pelayanan kesehatan terbatas. Metode yang digunakan adalah Systematic Literature Review (SLR) dengan pedoman PRISMA 2020. Metode ini dipilih karena memungkinkan identifikasi, seleksi, evaluasi, dan sintesis bukti ilmiah secara sistematis dan transparan. Dari 126 artikel yang teridentifikasi, 31 artikel duplikat dihapus, 95 artikel menjalani screening, 22 artikel dinilai berdasarkan full text, dan 5 artikel memenuhi kriteria inklusi untuk sintesis. Hasil penelitian menunjukkan bahwa urgensi appendektomi profilaksis tidak dapat ditentukan secara universal, tetapi dipengaruhi oleh probabilitas apendisitis, durasi paparan, keterbatasan akses pelayanan medis dan evakuasi, serta dampak terhadap pelaksanaan tugas. Bukti menunjukkan komplikasi prosedur profilaksis relatif rendah pada populasi terpilih, tetapi tindakan tetap memiliki risiko. Kesimpulannya, appendektomi profilaksis lebih tepat diposisikan sebagai strategi mitigasi risiko yang selektif dan berbasis risk–benefit assessment. Penelitian lanjutan diperlukan untuk mengembangkan instrumen penilaian risiko dan kriteria klinis-operasional yang lebih objektif.
Downloads
References
Almada, M. A., et al. (2018). Results in prophylactic appendectomy prior military Antarctic expedition. Journal of the American College of Surgeons, 227(4 Suppl. 2), e183. https://doi.org/10.1016/j.jamcollsurg.2018.08.499
Baker, J. B., Northern, D. M., Frament, C., Baker, D. A., Remick, K., Seery, J., Stephens, L., Shackelford, S., & Gurney, J. (2021). Austere resuscitative and surgical care in support of forward military operations—Joint Trauma System position paper. Military Medicine, 186(1–2), 12–17. https://doi.org/10.1093/milmed/usaa358
Becerra, D., et al. (2025). Concurrent surgical care in an austere military setting: A preparation for mass casualty events. Military Medicine, 190(9–10), e1806–e1810. https://doi.org/10.1093/milmed/usaf012
Bitterman, A., et al. (2020). Practicing military medicine in truly austere environments: What to expect, how to prepare, when to improvise. Military Medicine, 185(5–6), e656–e661. https://doi.org/10.1093/milmed/usz467
Blackbourne, L. H., Baer, D. G., Eastridge, B. J., & Kheirabadi, B. (2017). Prolonged field care: Beyond the “golden hour.” Surgical Clinics of North America, 97(5), 1061–1075. https://doi.org/10.1016/j.suc.2017.06.001
CODA Collaborative. (2020). A randomized trial comparing antibiotics with appendectomy for appendicitis. New England Journal of Medicine, 383(20), 1907–1919. https://doi.org/10.1056/NEJMoa2014320
Di Saverio, S., Podda, M., De Simone, B., Ceresoli, M., Augustin, G., Gori, A., Boermeester, M., Sartelli, M., Coccolini, F., Tarasconi, A., De’Angelis, N., Weber, D. G., Tolonen, M., Birindelli, A., Biffl, W. L., Moore, E. E., Kelly, M., Søreide, K., Kashuk, J., & Catena, F. (2020). Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World Journal of Emergency Surgery, 15, Article 27. https://doi.org/10.1186/s13017-020-00306-3
Hansson, J., Körner, U., Khorram-Manesh, A., Solberg, A., & Lundholm, K. (2009). Randomized clinical trial of antibiotic therapy versus appendicectomy as primary treatment for acute appendicitis in unselected patients. British Journal of Surgery, 96(5), 473–481.
Johnson, P. (2023). Prophylactic appendicectomy and cholecystectomy prior to prolonged expedition in extreme environments. BJS, 110(Supplement_3), znad101.110. https://doi.org/10.1093/bjs/znad101.110
Livingston, E. H. (2018). Antibiotic treatment for uncomplicated appendicitis really works: Results from 5 years of observation in the APPAC trial. JAMA, 320(12), 1245–1246. https://doi.org/10.1001/jama.2018.13368
Louw, J., McCaul, M., English, R., Nyasulu, P. S., Davies, J., Fourie, C., Jassat, J., & Chu, K. M. (2023). Factors contributing to delays to accessing appendectomy in low- and middle-income countries: A scoping review. World Journal of Surgery, 47(12), 3060–3069. https://doi.org/10.1007/s00268-023-07183-2
Pannell, D., Nathens, A. B., Ricard, J., Savage, E., & Tien, H. (2015). Acute nontraumatic general surgical conditions on a combat deployment. Canadian Journal of Surgery, 58(3 Suppl. 3), S135–S140. https://doi.org/10.1503/cjs.013414
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., & Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71
Salminen, P., Paajanen, H., Rautio, T., Nordström, P., Aarnio, M., Rantanen, T., Tuominen, R., Hurme, S., & Grönroos, J. M. (2015). Antibiotic therapy vs appendectomy for treatment of uncomplicated acute appendicitis: The APPAC randomized clinical trial. JAMA, 313(23), 2340–2348. https://doi.org/10.1001/jama.2015.6154
Salminen, P., Tuominen, R., Paajanen, H., Rautio, T., Nordström, P., Aarnio, M., Rantanen, T., Hurme, S., Mecklin, J.-P., Sand, J., Virtanen, J., Jartti, A., & Grönroos, J. M. (2018). Five-year follow-up of antibiotic therapy for uncomplicated acute appendicitis in the APPAC randomized clinical trial. JAMA, 320(12), 1259–1265. https://doi.org/10.1001/jama.2018.13201
Sippola, S., Grönroos, J., Tuominen, R., Paajanen, H., Rautio, T., Nordström, P., Aarnio, M., Rantanen, T., Hurme, S., Mecklin, J.-P., Sand, J., Virtanen, J., Jartti, A., & Salminen, P. (2020). Economic evaluation of antibiotic therapy versus appendicectomy for treatment of uncomplicated acute appendicitis: 5-year results of the APPAC randomized clinical trial. PLoS ONE, 15(1), e0229162. https://doi.org/10.1371/journal.pone.0229162
Snyder, H. (2019). Literature review as a research methodology: An overview and guidelines. Journal of Business Research, 104, 333–339. https://doi.org/10.1016/j.jbusres.2019.07.039
Uribe, S., Vallejo, D., Jorquera, M., Contreras, L., & Celedón, F. (2020). Apendicectomía profiláctica en la dotación Antártica: Experiencia del Hospital de la Fuerza Aérea de Chile. Revista de Cirugía, 72(6), 530–535.
Vons, C., Barry, C., Maitre, S., Pautrat, K., Leconte, M., Costaglioli, B., Karoui, M., Alves, A., Dousset, B., Valleur, P., & Antibiotics Versus Surgery Study Group. (2011). Amoxicillin plus clavulanic acid versus appendicectomy for treatment of acute uncomplicated appendicitis: An open-label, non-inferiority, randomised controlled trial. The Lancet, 377(9777), 1573–1579. https://doi.org/10.1016/S0140-6736(11)60410-8
Downloads
Published
Issue
Section
Citation Check
License
Copyright (c) 2026 Candra B Prasetyo, Hari Budiman, Muhammad Irfan
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors are copyright holders and maintain author rights in accordance with the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) or comparable license. While holding these rights, authors grant the JETISH: Journal of Education Technology Information Social Sciences and Health (publisher of JETISH) a non-exclusive right to the first publication of their articles, including abstracts. This enables us to ensure full copyright protection and to disseminate the article to the widest possible readership in electronic format. Authors are themselves responsible for obtaining permission to reproduce copyright material from other sources.
