<Illustration by 유진수, 메디컬일러스트 그리닥>

이 일러스트는 삼성서울병원 소아외과팀과의 작업으로 그려졌습니다. Surgical Endoscopy에 2016년에 accept되었습니다. 소아외과 영역에서 복강경은 많이 발전을 이루고 있지만 아직 자리잡았다고 보기는 힘듭니다. 선천적으로 십이지장이 막혀있는 십이지장폐쇄 (Duodenal atresia)의 수술을 복강경으로 시행하면서 문합 (anastomosis) 방법을 다이아몬드 형상 (Diamond-shaped anastomosis)으로 하는 경우가 많지만 이 논문에서는 parallel anastomosis 방법의 결과를 소개하고 있습니다.



논문에는 두 개의 일러스트가 있습니다. Figure 1은 수술인력 및 포트 배치도로, 기존의 칙칙한 지도같은 배때기 형식을 벗어난 위트있는 그림을 추구했고 이런  SCI 저널에 농담같은 그림이 올라온 것이 기쁠따름입니다.


두번째 Figure 2는 수술 술식의 과정을 보여주는데, A부터 E까지 차례대로 한다는 것을 설명하는 그림입니다.

그리고 논문에 실리지는 않았지만 십이지장폐쇄를 설명하는 그림도 있었습니다.duo-atresia-1-a

<Illustration by Jinsoo Rhu, 메디컬일러스트 그리닥>


Currently, a diamond-shaped anastomosis is preferred for the surgical repair of duodenal atresia (DA) in both open and laparoscopic surgery. We report the results of laparoscopic duodenoduodenostomy with parallel anastomosis (LDPA) in DA.


We retrospectively reviewed 22 patients who underwent laparoscopic duodenoduodenostomy from February 2005 to May 2015 in Samsung Medical Center. All patients underwent operation within the first month after birth. Patients who were transversely anastomosed after duodenotomy and patients who underwent simultaneous operation on combined anomalies were excluded. Parallel anastomosis was used in all surgeries. Four trocars were used in laparoscopic repair. After mobilization of both proximal and distal ends, the proximal end was incised transversely and the distal end was incised longitudinally. Duodenoduodenostomy with parallel anastomosis using a 5-0 glyconate monofilament was performed with interrupted sutures.


Eleven patients (50 %) were male. Median gestational age was 36 + 6 weeks (32 + 7-40 + 6). Median age at the time of operation and median body weight were 3 days (1-12) and 2.53 kg (1.63-3.18), respectively. All patients were diagnosed prenatally and 16 patients (72.7 %) had associated anomalies. Median operation time was 142 min (96-290) and median postoperative day to start oral feeding was 5 days (3-9) and median postoperative day of reaching full feeding was 11 days (6-19). Median postoperative day was 13 days (10-60). There was no anastomotic leakage or stenosis. Median follow up was 3.5 months (1-21). Currently, there is no late complication.


LDPA can be performed easily to patients who have DA in neonatal period. It is anatomically natural and the risk of leakage or stenosis does not seem significant. Therefore, parallel anastomosis should be considered as a safe procedural option for laparoscopic duodenoduodenostomy in DA.