Introduction. The incidence of surgical site infections (SSIs) is reducing following the global campaign that requires all the stakeholder involvement. However, of all hospital-acquired infection prevention programs, wound irrigation is hard to be implemented in our hospital. There is a belief that the wound irrigation procedure leading to the spreading of infection. In contrast, the use of antiseptic and topical antibiotic, as well as systemic antibiotic, is uncontrolled high. Thus, we run a cost-effective study of wound irrigation to change the practice. Method. We carried out a prospective cohort study comparing wound irrigation and the standard protocol in wound care in those underwent median laparotomy during the period of January to July 2018. A total of 80 subjects enrolled in this study, which divided into two groups, 40 for each group. The first group was those treated using antiseptics (povidone-iodine) and antibiotic contained paraffin tulle, while the second group was those treated using irrigation. This study performed in the digestive surgery division, which initiated irrigation protocol for wound irrigation. Stitch specimen taken for bacterial culture proceeded on 7 th day postoperative and clinical signs of infection following CDC criteria was observed then statistically analyzed. Results. The bacterial culture showed no significant difference (p = 0.82) between the two groups. Clinical signs are showing no significant difference between the two groups (p = 1.00). In the cost perspective, the application of wound irrigation saving IDR 57,500,00 or four USD per subject. Conclusion: Wound irrigation using distilled water efficiently prevent SSIs.

Latar Belakang. Sindroma Marfan merupakan penyakit jaringan ikat yang diturunkan secara autosom dominan dengan penyebab utama morbiditas dan mortalitas akibat kelainan aorta. Bedah terbuka merupakan tata laksana utama untuk kelainan aorta pada pasien sindrom Marfan, namun tidak semua pasien dapat dilakukan bedah terbuka, misalkan pada kondisi hemodinamik yang tidak stabil dan usia tua. Intervensi endovaskular merupakan salah satu pendekatan tata laksana minimal invasif yang masih kontroversial karena adanya risiko kegagalan primer berupa kebocoran aneurisma. Metode. Penelusuran literatur dilakukan secara daring pada 3 database: PubMed, ClinicalKey, dan ScienceDirect. Dilakukan pemilihan studi berdasarkan kriteria inklusi dan eksklusi literatur. Artikel terpilih ditelaah secara kritis berdasarkan alur seleksi dari PRISMA Flow Diagram. Didapatkan 6 artikel yang ditelaah secara kritis Hasil. Tiga literatur mengenai prosedur endovaskular menunjukkan angka keberhasilan prosedur berkisar 20%-38% dengan risiko kegagalan primer (primary endoleak) yang cukup tinggi. Kematian akibat aneurisma lebih tinggi pada pasien sindrom Marfan yang menjalani teknik endovaskular dibandingkan pasien yang dilakukan bedah terbuka. Kesimpulan. Prosedur endovaskular dapat dijadikan alternatif tatalaksana dengan mempertimbangkan kondisi pasien. Sedikitnya jumlah subyek pada penelitian-penelitian yang ada serta waktu follow-up yang singkat menyebabkan efektivitas teknik endovaskular masih diragukan jika dibandingkan dengan prosedur bedah terbuka. Kata kunci: sindrom marfan, endovaskular, bedah terbuka, aneurisma aorta, torako-abdominal