<Illustration by Jinsoo Rhu, 메디컬일러스트 그리닥>

삼성서울병원 소아외과팀과 함께한 일러스트입니다. 선천성 거대결장 Hirschsprung disease에서 수술을 시행했을 때 문합의 위치가 치상선 (dentate line)에서 2mm이냐 15mm이냐에 따라 환아의 수술 후 배변습관에 어떤 변화가 있는지 분석하는 논문이었습니다.hirsch1

hirsch2

일러스트는 흑백, 선으로만 제작되었습니다. Figure 1의 A는 2mm에서 잘라서 문합했을 경우를 그리고 있고 Figure B는 15mm에서 잘라서 연결한 경우를 보여주고 있습니다. 그림이 어려울 것 같지 않을 것 처럼 느껴지겠지만 pull-through하는 대장을 감싸고 있는 장의 submucosal dissection된 것까지 표현해낸 아주 세밀한 그림이었습니다.

<Illustration by Jinsoo Rhu, 메디컬일러스트 그리닥>

Anorectal innervation that governs sensation, motor function, and rectal accommodation can be influenced by the type of surgical procedure used to treat children with Hirschsprung disease. At our institution, we began to perform single-stage, laparoscopy-assisted transanal endorectal pull-through (LATEP) with submucosal dissection and anastomosis of the ganglionated bowel at 2 different levels relative to the dentate line.This retrospective study describes postoperative stool frequency changes in response to this procedure. Forty infants who underwent single-stage LATEP between September 2003 and April 2012 in a single center by the same surgeon were included in our analysis.The patients were divided in 2 groups: Group A (n = 23) underwent submucosal dissection and anastomosis at 2 mm above the dentate line, and Group B (n = 17) underwent the same procedure with anastomosis 15 mm above the dentate line. Clinical characteristics, clinical findings on the first postoperative visit, and instances of coexisting anomalies did not differ between the 2 groups. Aganglionic segments were found in the rectosigmoid colon in 18 cases (78.2%) in Group A and in 15 cases (88.2%) in Group B. Although the stool frequency was no different at 1, 3, 6, and 12 months after the operation, Group B showed significantly fewer bowel movements than Group A after 2 years (3.77 in Group A vs 2.0 in Group B; P = 0.035) and after 3 years (3.92 vs 1.29; P = 0.009) in patients who had aganglionosis of the rectosigmoid colon. The mean follow-up period was 65.87 ± 28.08 months for Group A and 35.59 ± 18.68 for Group B.The level of submucosal dissection and anastomosis in single-stage LATEP influenced the stool frequency in rectosigmoid aganglionosis.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4998749/pdf/medi-95-e3092.pdf