Electronic Theses and Dissertation

Latar Belakang: Kolesistektomi laparoskopi, yang merupakan baku emas pengobatan untuk kolelitiasis, memiliki risiko komplikasi (0,5-6%) dan konversi ke kolesistektomi terbuka (1-15%). Oleh karena itu, memprediksi hasil luaran tersebut sangatlah penting. Sistem penilaian (skor), seperti yang dikembangkan oleh Randhawa dan Pujahari, digunakan untuk menilai risiko ini. Selain itu, validasi eksternal diperlukan sebelum sebuah model prediksi dapat dianggap layak untuk diterapkan.

Tujuan: Penelitian ini bertujuan untuk melakukan uji diagnostik terhadap nilai preoperatif sistem skoring Randhawa dalam memprediksi tingkat kesulitan kolesistektomi laparoskopi di RSUD Dr. Zainoel Abidin, Banda Aceh.

Metode: Studi diagnostik ini dilakukan di RSUD Dr. Zainoel Abidin pada Agustus 2025 hingga Oktober 2025 dengan melibatkan 40 pasien kolesistektomi laparoskopi. Pasien dinilai secara preoperatif menggunakan sistem Randhawa. Temuan intraoperatif seperti durasi, komplikasi, dan konversi dicatat, kemudian kesulitan pembedahan dikategorikan menjadi mudah, sulit, dan sangat sulit berdasarkan skor preoperatif dan temuan intraoperatif. Studi ini kemudian mengevaluasi sensitivitas, spesifisitas, akurasi, Nilai Duga Positif (NDP), Nilai Duga Negatif (NDN), dan Area Under the Curve (AUC) dari Nilai Preoperatif Sistem Skoring Randhawa.

Hasil: Nilai preoperatif sistem skoring Randhawa memiliki nilai AUC sebesar 0,836, yang dikategorikan baik, dengan sensitivitas 56,25%, spesifisitas 87,5%, akurasi 75%, NDP 75%, dan NDN 70%. Terdapat hubungan yang signifikan antara riwayat rawat inap akibat kolesistitis akut dengan tingkat kesulitan kolesistektomi
laparoskopik (p=0,009)

Kesimpulan: Nilai preopratif sistem skoring skor Randhawa dapat diandalkan dan bermanfaat dalam memprediksi kesulitan kolesistektomi laparoskopi.

Kata Kunci: Kolesistektomi, Laparoskopi, Kolelitiasis, Prediksi, Kesulitan

Background: Laparoscopic cholecystectomy (LC), the gold standard treatment for cholelithiasis, carries risks of complications (0.5-6%) and conversion to open surgery (1-15%). Therefore, predicting these outcomes is crucial. Scoring systems, such as the one developed by Randhawa and Pujahari, are used to assess this risk. In addition, external validation is necessary before a prediction model can be justified for implementation. Objective: The aim of this study was to perform a diagnostic test on the preoperative value of the Randhawa scoring system in predicting the level of difficulty of LC at Dr. Zainoel Abidin Regional General Hospital, Banda Aceh. Methods: This diagnostic study at Dr. Zainoel Abidin Hospital from August 2025 to October 2025 which enrolled 40 laparoscopic cholecystectomy (LC) patients. Patients were scored preoperatively using the Randhawa system. Intraoperative outcomes such as duration, complications, and conversion were recorded, then the surgical difficulty was categorized as easy, difficult, and very difficult based on preoperative scores and intraoperative findings. The study then evaluated the Randhawa preoperative scoring system's sensitivity, specificity, accuracy, PPV, NPV, and AUC. Results: The Randhawa preoperative scoring system had an Area Under the Curve (AUC) value of 0.836, which is categorized as good, with a sensitivity of 56.25%, specificity of 87.5%, accuracy of 75%, PPV of 75%, and NPV of 70%. There is a significant association between a history of hospitalization for acute cholecystitis and the difficulty of laparoscopic cholecystectomy (p=0.009). Conclusion: The Randhawa preoperative scoring system is reliable and beneficial in predicting difficulty of LE. Keywords: Laparoscopic cholecystectomy, cholelithiasis, Randhawa preoperative scoring system, difficulty level