Faktor-Faktor yang Berhubungan dengan Gangguan Fungsi Defekasi Pasca Posterior Sagittal Anorectoplasty (PSARP) pada Pasien Malformasi Anorektal

Background: Anorectal malformation (ARM) is a common congenital anomaly frequently encountered in pediatric surgery. The primary surgical management for ARM is the Posterior Sagittal Anorectoplasty (PSARP) procedure. However, failure to regulate defecation function postoperatively can lead to severe complications such as megarectum, megasigmoid, fecal impaction, and overflow incontinence. Currently, there is no comprehensive study in Indonesia investigating the factors influencing defecation function in patients after PSARP surgery. Methods: This study employed a retrospective analytical observational design. Data were sourced from the medical records of ARM patients who underwent PSARP and were hospitalized at Prof. dr. I.G.N.G. Ngoerah General Hospital in Denpasar, from July 2019 to 2023. Consecutive sampling was used for subject recruitment. Data analysis was performed using SPSS version 25, including descriptive analysis, normality tests, bivariate analysis, and multivariate analysis. Result: Out of 36 study subjects, 13 (36%) experienced defecation dysfunction, while 23 (64%) did not. Bivariate analysis revealed that gender (OR=6.375; 95% CI=1.421-28.603; p=0.012), comorbidities (OR=23.625; 95% CI=3.647-153.038; p=0.000), and colostomy method (OR=6; 95% CI=1.080-33.321; p=0.030) were significantly associated with postoperative defecation dysfunction. Furthermore, age (p=0.000), age at surgery (p=0.002), operation duration (p=0.002), and hospitalization duration (p=0.014) also showed a relationship. Multivariate analysis identified comorbidities as the most significant contributing risk factor (Adjusted OR=0.054; p=0.006). Conclusion: Gender, comorbidities, colostomy method, age, age at surgery, operation duration, and hospitalization duration are associated with postoperative defecation dysfunction following PSARP, with comorbidities being the most influential risk factor. Metode: Penelitian ini merupakan studi observasional analitik retrospektif. Data diambil dari rekam medis pasien MAR yang menjalani prosedur PSARP dan dirawat inap di RSUP Prof. dr. I.G.N.G. Ngoerah Denpasar antara Juli 2019 hingga 2023. Pengambilan sampel dilakukan menggunakan metode consecutive sampling. Analisis data dilakukan dengan SPSS versi 25, meliputi analisis deskriptif, uji normalitas, serta analisis bivariat dan multivariat. Hasil: Dari 36 subjek penelitian, 13 (36%) mengalami gangguan fungsi defekasi dan 23 (64%) tidak. Hasil analisis bivariat menunjukkan bahwa jenis kelamin (OR=6,375; IK95%=1,421-28,603; p=0,012), komorbiditas (OR=23,625; IK95%=3,647-153,038; p=0,000), dan metode kolostomi (OR=6; IK95%=1,080-33,321; p=0,030) berhubungan signifikan dengan gangguan fungsi defekasi pasca-PSARP. Selain itu, usia (p=0,000), usia saat operasi (p=0,002), durasi operasi (p=0,002), dan durasi perawatan rumah sakit (p=0,014) juga menunjukkan hubungan. Analisis multivariat mengidentifikasi komorbiditas sebagai faktor risiko paling signifikan (Adjusted OR=0,054; p=0,006). Kesimpulan: Jenis kelamin, komorbiditas, metode kolostomi, usia, usia saat operasi, durasi operasi, dan durasi perawatan rumah sakit berhubungan dengan gangguan fungsi defekasi pasca-PSARP. Komorbiditas merupakan faktor risiko paling berperan dalam gangguan fungsi defekasi pasca-PSARP.