Digestive tract reconstruction is an important part of gastrointestinal surgery. With the rapid development and wide application of stapler technology, more and more surgeons choose mechanical anastomosis to complete digestive tract reconstruction. Compared with manual suture, mechanical anastomosis can significantly shorten the operation time and reduce the number of days in hospital. However, it is not easy to select a suitable anastomotic instrument from a wide variety of surgical instruments and perform standardized operations. This article summarizes and evaluates the selection and rational application of staplers in gastrointestinal surgery.
There are many types of staplers, which can be divided into press-fit type and staple-type according to the working principle. According to the shape of the stapler, it is divided into linear stapler, circular stapler, arc cutting stapler, button-shaped stapler and paperclip stapler.
1. Proximal gastrectomy:
During the operation, a circular stapler is generally used for esophagogastric anastomosis, and a linear cutting stapler (TLC10) is used for gastric dissection. Studies have shown that the use of a 25 mm stapler during esophageal and gastrointestinal anastomosis can reduce the incidence of postoperative complications . But this is not absolute. The operator must determine the type of stapler according to the inner diameter of the esophagus. During anastomosis, pay attention to keeping the central rod of the stapler body and the anvil seat tightly connected for 20 s, which is conducive to tissue shaping and reduces anastomotic bleeding. Do not forcibly pull the stapler out, especially when the incision is incomplete, it may easily cause the anastomotic tissue to tear off.
2. Distal gastrectomy:
End-to-side or end-to-end gastroduodenal anastomosis of Bi type I, side-to-side gastrojejunostomy of Bi type II and Roux-en-Y gastrojejunum anastomosis are mainly used.
In the Bi I type, circular staplers and linear staplers are used for anastomosis. Some scholars suggest end-to-end anastomosis of gastroduodenum, so that the tension of the anastomosis is small. If the anastomotic tension is too high, the risk of anastomotic leakage will increase after operation. Although the operation of end-to-end anastomosis is complicated, as long as sufficient blood supply and tension-free anastomosis are ensured, there is no significant difference in the incidence of postoperative complications between the two anastomotic methods.
3. Total gastrectomy
The use of circular staplers in gastrojejunostomy and esophagojejunostomy has been widely accepted, and most surgeons prefer to use circular staplers in open surgery.
It is recommended to choose a linear stapler or even a laparoscopic stapler in laparotomy digestive tract reconstruction because:
(1) This type of device is convenient and simple to operate, avoiding cumbersome operation steps such as purse-string suture, anvil insertion, and circular stapler passing through the intestinal cavity;
(2) The anastomosis is not limited by the lumen diameter;
(3) There is less bleeding during the anastomosis, and it is not easy to cause tissue tearing, damage or incomplete anastomosis during anastomosis;
(4) shorten the operation time;
(5) Compared with the circular stapler, the linear stapler only needs to replace the staple cartridge when it is used multiple times during the operation, which reduces the operation cost.