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PERBANDINGAN PEMAKAIAN CEFTRIAXONE TERHADAP INFEKSI LUKA OPERASI PADA PASIEN APENDISITIS AKUT NON KOMPLIKATA YANG DILAKUKAN LAPARATOMI DAN LAPARASKOPI APENDIKTOMI Ilham Farizal; Sigit Adi Prasetyo; Endang Sri Lestari
Jurnal Kedokteran Diponegoro (Diponegoro Medical Journal) Vol 5, No 4 (2016): JURNAL KEDOKTERAN DIPONEGORO
Publisher : Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia

Latar belakang : Banyaknya pemberian antibiotik Ceftriaxone pada pasien apendisitis akut non komplikasi yang dilakukan laparaskopi dan laparatomi apendiktomi dikhawatirkan menjadi salah satu penyebab timbulnya infeksi luka operasi (ILO). Ceftriaxone memang memiliki indeks teraupeutik yang tinggi. Namun spektrum antibiotik yang luas dikhawatirkan akan membunuh flora normal. Hal ini dikhawatirkan dapat mengakibatkan resistensi antibiotik dan angka kejadian ILO semakin bertambah.Tujuan : Mengetahui perbedaan pemakaian antibiotik ceftriaxone dan non ceftriaxone terhadap infeksi luka operasi operasi (ILO) pada pasien apendisitis akut non komplikata yang dilakukan laparatomi dan laparaskopi apendiktomi.Metoda : Penelitian dilakukan dengan menggunakan data sekunder rekam medik RSUP Dr.Kariadi tahun 2013-2016. Pengambilan data pasien apendisitis akut non komplikata diambil berdasarkan kelompok yang diberi antibiotik profilaksis ceftriaxone dan non ceftriaxone baik laparoskopi dan laparotomi apendiktomi. Data tersebut diuji dengan pengujian Mann-Whitney non parametrik 2 variabel kategorik tidak berpasangan antara antibiotik ceftriaxone-non ceftriaxone dengan tanda-tanda ILO. Kedua variabel dianalisis berdasarkan kelompok secara keseluruhan, laparoskopi, dan laparotomy. Setelah itu dilihat nilai signifikansinya.Hasil : Jumlah pasien yang dilakukan tindakan laparatomi apendiktomi sebesar 54,8% (17/31). Dari 17 pasien yang dilakukan laparatomi,70,5% diberikan antibiotik ceftriaxone dan 11,7% diberikan antibiotik non ceftriaxone. Sedangkan jumlah pasien yang dilakukan tindakan laparaskopi apendiktomi sebesar 45,2% (14/31). Dari 14 pasien yang dilakukan laparaskopi, 64,2% diberikan antibiotik ceftriaxone dan 35,7% diberian antibiotik non ceftriaxone. Tidak ada perbedaan yang bermakna antara pemberian antibiotik ceftriaxone dan non ceftriaxone terhadap infeksi luka operasi setelah dilakukan laparatomi apendiktomi (p=0,793). Tidak ada perbedaan yang bermakna antara pemberian antibiotik ceftriaxone dan non ceftriaxone terhadap infeksi luka operasi setelah dilakukan laparaskopi apendiktomi (p=0,273).Simpulan : Tidak ada perbedaan yang bermakna antara kejadian infeksi luka operasi terhadap pemberian antibiotik ceftriaxone dan non ceftriaxone baik yang dilakukan laparoskopi apendiktomi maupun laparotomi apendiktomi.

PERBANDINGAN PEMBERIAN ANTIBIOTIK PROFILAKSIS CEFTRIAXON DAN NON-CEFTRIAXON TERHADAP KEJADIAN SURGICAL SITE INFECTION PASCA KOLESISTEKTOMI Alexander Lim; Sigit Adi Prasetyo; Rebriarina Hapsari
DIPONEGORO MEDICAL JOURNAL (JURNAL KEDOKTERAN DIPONEGORO) Vol 6, No 2 (2017): JURNAL KEDOKTERAN DIPONEGORO
Publisher : Faculty of Medicine, Diponegoro University, Semarang, Indonesia

Latar belakang : Surgical Site Infection (SSI) merupakan salah satu komplikasi pascaoperasi yang harus dihindari. Penggunaan antibiotik profilaksis diharapkan dapat mengurangi kejadian SSI. Pemilihan jenis antibiotik profilaksis yang tepat dibutuhkan agar penggunaan antibiotik menjadi rasional dan efektif.Tujuan : Membandingkan pemberian antibiotik profilaksis ceftriaxone dan non ceftriaxone terhadap kejadian SSI pada pasien kolesistolitiasis yang dilakukan laparoskopi dan laparotomi kolesistektomi.Metode : Penelitian ini merupakan penelitian observasional dengan metode penelitian cross sectional, dilaksanakan di bagian rekam medik RSUP Dr. Kariadi Semarang. Pasien dibagi menjadi kelompok yang diberikan antibiotik ceftriaxone dan non ceftriaxone baik yang dilakukan laparoskopi kolesistektomi atau laparotomi kolesistektomi. Data tersebut dianalisis dengan uji Fisher dan perhitungan risiko dengan Prevalnce Ratio menggunakan tabel 2x2.Hasil : Diantara variabel yang diteliti hanya variabel jenis kelamin yang bermakna dengan nilai p = 0,023. Sedangkan untuk perbedaan jenis pemberian antibiotik profilaksis (p = 0,636) dan jenis tindakan operasi (p = 0,066) tidak bermakna. Uji regresi logistik untuk variabel jenis kelamin dan umur tidak bisa dilakukan. Jenis operasi laparotomi kolesistektomi memiliki risiko 4,583 lebih besar untuk terjadinya SSI (Interval Kepercayaan 95% = 1,050 - 20,003)Kesimpulan : Tidak ada perbedaan yang bermakna antara pemberian antibiotik profilaksis ceftriaxone dan non ceftriaxone pada pasien kolesistolitiasis yang dilakukan laparoskopi atau laparotomi kolesistektomi terhadap kejadian SSI.

Beetroot (Beta vulgaris) Extract: A Potential Therapeutic Agent for Modulating Post-Cholecystectomy Colonic Inflammation? An In Vivo Evidence Review Mahmudin Ardian Ashadi; Sigit Adi Prasetyo; Yora Nintida
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 4 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i4.1262

Background: Cholecystectomy, while a common and effective treatment for symptomatic gallstones, can induce alterations in bile flow and gut microbiota composition, potentially leading to colonic inflammation. Beetroot (Beta vulgaris) extract, rich in betalains, nitrates, and other bioactive compounds, has demonstrated anti-inflammatory and antioxidant properties in various models. This systematic review evaluates the in vivo evidence for the efficacy of beetroot extract in modulating colonic inflammation following cholecystectomy. Methods: A systematic search of PubMed, Scopus, Web of Science, and Embase databases was conducted from January 2013 to May 2024, using keywords related to "beetroot," "Beta vulgaris," "cholecystectomy," "colon," "inflammation," and "in vivo." Studies investigating the effects of beetroot extract on colonic inflammation in animal models post-cholecystectomy were included. Data on inflammatory markers, histological changes, oxidative stress markers, and gut microbiota alterations were extracted. Results: Seven in vivo studies met the inclusion criteria. Beetroot extract administration was associated with significant reductions in colonic levels of pro-inflammatory cytokines (TNF-α, IL-6, IL-1β) in five studies. Data showed an average reduction of TNF-α by 35% (p < 0.01), IL-6 by 28% (p < 0.05), and IL-1β by 42% (p < 0.001) across these five studies. Four studies reported improvements in histological scores of colonic inflammation, indicating reduced tissue damage. Three studies demonstrated a decrease in MPO activity, a marker of neutrophil infiltration, with data showing an average reduction of 25% (p < 0.05). Conclusion: The available in vivo evidence, albeit limited, suggests that beetroot extract possesses significant potential for mitigating colonic inflammation following cholecystectomy. The observed anti-inflammatory effects are likely mediated by a combination of betalain-induced antioxidant and anti-inflammatory actions, nitrate-derived nitric oxide signaling, and modulation of the gut microbiota.

Modulation of Inflammatory and Regenerative Pathways by Channa striata Extract in End-to-End Anastomotic Wound Repair: A Systematic Review Faizurrahman Andi Kusuma; Sigit Adi Prasetyo; Endang Sri Lestari
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 4 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i4.1264

Background: Intestinal anastomotic healing is a complex process, often complicated by inflammation and impaired regeneration, leading to leakage and stricture. Channa striata (snakehead fish) extract, traditionally used for wound healing, possesses bioactive compounds with potential anti-inflammatory and regenerative properties. This systematic review aimed to critically appraise the in vivo evidence for the effects of Channa striata extract on inflammatory and regenerative pathways in end-to-end anastomotic wound repair. Methods: A comprehensive search of PubMed/MEDLINE, Scopus, Web of Science, Embase, and Cochrane Library databases was conducted for studies published between 2013 and 2024. Inclusion criteria comprised in vivo studies using animal models with end-to-end intestinal anastomosis, evaluating Channa striata extract versus a control, and reporting on relevant inflammatory and regenerative markers. Data extraction and risk of bias assessment (using SYRCLE's tool) were performed. Results: Seven studies met the inclusion criteria. These studies, primarily using rat models, demonstrated that Channa striata extract significantly modulated key inflammatory and regenerative pathways. Specifically, the extract reduced pro-inflammatory cytokines, increased anti-inflammatory cytokines, enhanced growth factor expression, and promoted collagen deposition at the anastomotic site. These effects were associated with improved anastomotic bursting pressure and reduced leakage rates. Risk of bias varied across studies, with some limitations in blinding and allocation concealment. Conclusion: Channa striata extract shows promise as a therapeutic agent for promoting anastomotic healing by modulating key inflammatory and regenerative pathways. However, further high-quality, standardized studies are needed to confirm these findings, elucidate precise mechanisms, and optimize extract formulation and dosage before clinical translation.

Beta vulgaris Extract as a Post-Cholecystectomy Dietary Intervention: A Systematic Review of its Effects on Gut Microbial Balance, Bile Acid Metabolism, and E. Coli/Lactobacillus Dynamics Benedick Johanes Alvian; Sigit Adi Prasetyo; Yora Nintida
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 5 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i5.1267

Background: Cholecystectomy, while a common surgical procedure, significantly alters bile acid dynamics and the gut microbiome, potentially leading to an imbalance favoring opportunistic pathogens like Escherichia coli over beneficial bacteria like Lactobacillus. This systematic review investigates the potential of beetroot (Beta vulgaris) extract, rich in betalains and prebiotic fibers, as a dietary intervention to mitigate these post-cholecystectomy microbial shifts. Methods: A systematic search of PubMed, Scopus, Web of Science, and Cochrane Library databases was conducted for studies published between 2013 and 2024. Keywords included "cholecystectomy," "gallbladder removal," "bile acids," "Escherichia coli," "Lactobacillus," "beetroot," "Beta vulgaris," "prebiotic," "gut microbiome," and related terms. Studies investigating the effects of Beta vulgaris (or its constituents) on gut microbial composition, bile acid metabolism, or relevant clinical outcomes in post-cholecystectomy contexts (human or animal models) were included. Quality assessment was performed using the Cochrane Risk of Bias 2.0 tool for randomized controlled trials (RCTs) and the ROBINS-I tool for non-randomized studies. Results: Seven studies met the inclusion criteria: three human RCTs, two animal studies (rats), and two in vitro studies. The human studies were of moderate to high risk of bias. The animal studies had a lower risk of bias but limited direct applicability to humans. The in vitro studies provided mechanistic insights but lacked the complexity of the in vivo environment. Due to the heterogeneity of study designs and outcome measures, a meta-analysis was not feasible. Beetroot extract supplementation (standardized to betalain content) was associated with a significant increase in Lactobacillus abundance (mean increase of 15%, p < 0.05) and a decrease in E. coli abundance (mean decrease of 10%, p < 0.05) in the post-cholecystectomy gut. There was also a shift in bile acid profiles, with an increase in secondary bile acids known to be less inhibitory to Lactobacillus. Conclusion: While existing evidence is limited, the theoretical basis and preliminary findings suggest that beetroot extract holds promise as a post-cholecystectomy dietary intervention to promote a healthier gut microbiome. Further high-quality, well-powered RCTs are warranted to confirm these potential benefits and elucidate the underlying mechanisms.

The Role of Channa striata in Attenuating Inflammatory Markers (PCT, TNF-α, CRP) Following Intestinal Anastomosis in Hyperglycemic Rats: A Systematic Review and Dose-Response Meta-Analysis Anangga Haryanto; Endang Sri Lestari; Sigit Adi Prasetyo
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 5 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i5.1270

Background: Hyperglycemia impairs wound healing and exacerbates inflammation, increasing the risk of complications following intestinal anastomosis. Channa striata (snakehead fish) extract, traditionally used for wound healing, contains bioactive compounds with potential anti-inflammatory properties. This systematic review and meta-analysis aimed to evaluate the dose-dependent effects of C. striata extract on procalcitonin (PCT), tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP) levels in hyperglycemic rats undergoing end-to-end intestinal anastomosis. Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, and Cochrane Library databases for studies published between 2013 and 2024. Inclusion criteria were: studies using hyperglycemic rat models, end-to-end intestinal anastomosis, C. striata extract administration (with varying doses), and measurement of PCT, TNF-α, and/or CRP. Data extraction included study characteristics, animal model details, C. striata extraction method and dosage, and inflammatory marker levels at various time points. Risk of bias was assessed using the SYRCLE's RoB tool. A random-effects meta-analysis was performed to estimate the standardized mean difference (SMD) in inflammatory marker levels between C. striata-treated and control groups. Dose-response relationships were explored using meta-regression. Results: Seven studies met the inclusion criteria. C. striata extract was administered via various routes (oral, intraperitoneal) and at different doses (ranging from 100 mg/kg to 1000 mg/kg). Meta-analysis revealed a significant reduction in PCT levels (SMD = -1.25, 95% CI: -1.80, -0.70; p < 0.001), TNF-α levels (SMD = -1.55, 95% CI: -2.15, -0.95; p < 0.001), and CRP levels (SMD = -1.38, 95% CI: -1.98, -0.78; p < 0.001) in C. striata-treated groups compared to controls. Meta-regression indicated a significant dose-dependent relationship for TNF-α (p = 0.02) and CRP (p = 0.04), with higher doses showing greater reductions. Risk of bias assessment revealed some concerns in most studies, primarily related to blinding and random sequence generation. Conclusion: This systematic review and meta-analysis provides evidence that C. striata extract significantly reduces inflammatory markers (PCT, TNF-α, CRP) following intestinal anastomosis in hyperglycemic rats. A dose-dependent effect was observed for TNF-α and CRP, suggesting that higher doses may be more effective. Further high-quality studies with standardized protocols are needed to confirm these findings and determine optimal dosing regimens for clinical translation.

Beta vulgaris Extract as a Post-Cholecystectomy Dietary Intervention: A Systematic Review of its Effects on Gut Microbial Balance, Bile Acid Metabolism, and E. Coli/Lactobacillus Dynamics Benedick Johanes Alvian; Sigit Adi Prasetyo; Yora Nintida
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 5 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i5.1267

Background: Cholecystectomy, while a common surgical procedure, significantly alters bile acid dynamics and the gut microbiome, potentially leading to an imbalance favoring opportunistic pathogens like Escherichia coli over beneficial bacteria like Lactobacillus. This systematic review investigates the potential of beetroot (Beta vulgaris) extract, rich in betalains and prebiotic fibers, as a dietary intervention to mitigate these post-cholecystectomy microbial shifts. Methods: A systematic search of PubMed, Scopus, Web of Science, and Cochrane Library databases was conducted for studies published between 2013 and 2024. Keywords included "cholecystectomy," "gallbladder removal," "bile acids," "Escherichia coli," "Lactobacillus," "beetroot," "Beta vulgaris," "prebiotic," "gut microbiome," and related terms. Studies investigating the effects of Beta vulgaris (or its constituents) on gut microbial composition, bile acid metabolism, or relevant clinical outcomes in post-cholecystectomy contexts (human or animal models) were included. Quality assessment was performed using the Cochrane Risk of Bias 2.0 tool for randomized controlled trials (RCTs) and the ROBINS-I tool for non-randomized studies. Results: Seven studies met the inclusion criteria: three human RCTs, two animal studies (rats), and two in vitro studies. The human studies were of moderate to high risk of bias. The animal studies had a lower risk of bias but limited direct applicability to humans. The in vitro studies provided mechanistic insights but lacked the complexity of the in vivo environment. Due to the heterogeneity of study designs and outcome measures, a meta-analysis was not feasible. Beetroot extract supplementation (standardized to betalain content) was associated with a significant increase in Lactobacillus abundance (mean increase of 15%, p < 0.05) and a decrease in E. coli abundance (mean decrease of 10%, p < 0.05) in the post-cholecystectomy gut. There was also a shift in bile acid profiles, with an increase in secondary bile acids known to be less inhibitory to Lactobacillus. Conclusion: While existing evidence is limited, the theoretical basis and preliminary findings suggest that beetroot extract holds promise as a post-cholecystectomy dietary intervention to promote a healthier gut microbiome. Further high-quality, well-powered RCTs are warranted to confirm these potential benefits and elucidate the underlying mechanisms.

The Role of Channa striata in Attenuating Inflammatory Markers (PCT, TNF-α, CRP) Following Intestinal Anastomosis in Hyperglycemic Rats: A Systematic Review and Dose-Response Meta-Analysis Anangga Haryanto; Endang Sri Lestari; Sigit Adi Prasetyo
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 5 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i5.1270

Background: Hyperglycemia impairs wound healing and exacerbates inflammation, increasing the risk of complications following intestinal anastomosis. Channa striata (snakehead fish) extract, traditionally used for wound healing, contains bioactive compounds with potential anti-inflammatory properties. This systematic review and meta-analysis aimed to evaluate the dose-dependent effects of C. striata extract on procalcitonin (PCT), tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP) levels in hyperglycemic rats undergoing end-to-end intestinal anastomosis. Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, and Cochrane Library databases for studies published between 2013 and 2024. Inclusion criteria were: studies using hyperglycemic rat models, end-to-end intestinal anastomosis, C. striata extract administration (with varying doses), and measurement of PCT, TNF-α, and/or CRP. Data extraction included study characteristics, animal model details, C. striata extraction method and dosage, and inflammatory marker levels at various time points. Risk of bias was assessed using the SYRCLE's RoB tool. A random-effects meta-analysis was performed to estimate the standardized mean difference (SMD) in inflammatory marker levels between C. striata-treated and control groups. Dose-response relationships were explored using meta-regression. Results: Seven studies met the inclusion criteria. C. striata extract was administered via various routes (oral, intraperitoneal) and at different doses (ranging from 100 mg/kg to 1000 mg/kg). Meta-analysis revealed a significant reduction in PCT levels (SMD = -1.25, 95% CI: -1.80, -0.70; p < 0.001), TNF-α levels (SMD = -1.55, 95% CI: -2.15, -0.95; p < 0.001), and CRP levels (SMD = -1.38, 95% CI: -1.98, -0.78; p < 0.001) in C. striata-treated groups compared to controls. Meta-regression indicated a significant dose-dependent relationship for TNF-α (p = 0.02) and CRP (p = 0.04), with higher doses showing greater reductions. Risk of bias assessment revealed some concerns in most studies, primarily related to blinding and random sequence generation. Conclusion: This systematic review and meta-analysis provides evidence that C. striata extract significantly reduces inflammatory markers (PCT, TNF-α, CRP) following intestinal anastomosis in hyperglycemic rats. A dose-dependent effect was observed for TNF-α and CRP, suggesting that higher doses may be more effective. Further high-quality studies with standardized protocols are needed to confirm these findings and determine optimal dosing regimens for clinical translation.

Navigating a Complex Extraction: A Case Report on the Colonoscopic Management of Dual Rectal Foreign Bodies and a Proposed Treatment Algorithm Addy Saputro; Sigit Adi Prasetyo; Dimas Erlangga Nugrahadi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 9 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i9.1392

Background: The management of retained rectal foreign bodies (RFBs) constitutes a significant and escalating challenge in clinical practice. While general management principles exist, there is a paucity of literature detailing the specific biomechanical and pathophysiological complexities of cases involving dual, large-bodied foreign bodies of differing materials. The optimal instrumentation and the role of adjuvant maneuvers in these specific scenarios remain under-reported. Case presentation: A 60-year-old male presented with a three-day history of rectal pain and acute urinary retention after inserting a plastic bottle (18 cm x 7 cm) and a silicone dildo (20 cm x 6 cm) into his rectum. An initial attempt at manual extraction under sedation failed. The patient was subsequently managed under general anesthesia with a successful colonoscopic extraction. A 10-mm toothed alligator jaw grasper, used in conjunction with synchronized external abdominal compression, proved critical for retrieving both objects sequentially. The total procedural time was 60 minutes, and the patient was discharged after a 3-day hospital stay without complications. Conclusion: This case provides powerful validation for colonoscopic extraction as a safe, effective, and definitive minimally invasive technique for complex, high-lying RFBs when manual methods fail. It highlights the indispensable role of general anesthesia for achieving complete pelvic floor relaxation and the biomechanical superiority of specific retrieval tools. The successful outcome underscores the value of a systematic, stepwise management algorithm that prioritizes patient safety and minimizes the need for surgical intervention.

Navigating a Complex Extraction: A Case Report on the Colonoscopic Management of Dual Rectal Foreign Bodies and a Proposed Treatment Algorithm Addy Saputro; Sigit Adi Prasetyo; Dimas Erlangga Nugrahadi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 9 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i9.1392

Background: The management of retained rectal foreign bodies (RFBs) constitutes a significant and escalating challenge in clinical practice. While general management principles exist, there is a paucity of literature detailing the specific biomechanical and pathophysiological complexities of cases involving dual, large-bodied foreign bodies of differing materials. The optimal instrumentation and the role of adjuvant maneuvers in these specific scenarios remain under-reported. Case presentation: A 60-year-old male presented with a three-day history of rectal pain and acute urinary retention after inserting a plastic bottle (18 cm x 7 cm) and a silicone dildo (20 cm x 6 cm) into his rectum. An initial attempt at manual extraction under sedation failed. The patient was subsequently managed under general anesthesia with a successful colonoscopic extraction. A 10-mm toothed alligator jaw grasper, used in conjunction with synchronized external abdominal compression, proved critical for retrieving both objects sequentially. The total procedural time was 60 minutes, and the patient was discharged after a 3-day hospital stay without complications. Conclusion: This case provides powerful validation for colonoscopic extraction as a safe, effective, and definitive minimally invasive technique for complex, high-lying RFBs when manual methods fail. It highlights the indispensable role of general anesthesia for achieving complete pelvic floor relaxation and the biomechanical superiority of specific retrieval tools. The successful outcome underscores the value of a systematic, stepwise management algorithm that prioritizes patient safety and minimizes the need for surgical intervention.

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