Selection and Precautions of Surgical Stapler in Colorectal Operation

The advent of the surgical stapler provides convenience for gastrointestinal surgery, simplifies and shortens the operation time, and in the case of excluding instrument failures, theoretically, the probability of anastomotic complications caused by anastomosis with instruments should be lower than that of manual sutures, so the surgical stapler has its advantages and is favored by many surgeons.

Ⅰ. Selection and application of surgical staplers in colorectal surgery

1. Right hemicolectomy, end-to-side ileocolonic anastomosis:

The end-to-side anastomosis of the ileocolon can be performed with a circular stapler, and the transverse colon stump is closed with a linear closure. A side-to-side anastomosis of the transverse colon of the ileum can also be performed using a linear stapler. In transverse colon or left hemicolectomy and end-to-side anastomosis between colons, a circular stapler anvil should be placed in the proximal intestinal lumen.

2. Sigmoid colon or rectal resection, colorectal (anal canal) end-to-end anastomosis:

The double anastomosis technique is the most commonly used method in both laparotomy and laparoscopic reconstruction of the digestive tract. The proximal intestinal canal was inserted into the anvil of a circular stapler. The pre-cut part of the distal end of the tumor is closed with a straight or curved cutting stapler. Before the body of the surgical stapler is sent into the anal canal, the front end should be coated with povidone iodine solution for lubrication and disinfection. The device body must be slowly advanced in the anal canal until the front end of the device body gently touches the inside of the rectal stump.

Ⅱ. Precautions for the use of circular staplers

1. During the tightening process of the surgical stapler, prevent the proximal intestine from twisting, otherwise the mesangial blood vessels will be compressed;

2. The mesentery at both ends of the anastomosis should not be free too long to ensure sufficient blood supply to the intestine;

3. The adipose tissue at both ends of the intestinal tube at the anastomosis should be removed to prevent incomplete anastomosis caused by too much tissue embedded during the anastomosis, but it is best not to exceed the range of 2 cm, otherwise it will affect the blood supply of the intestinal tube at the anastomosis;

4. During anastomosis, it is necessary to prevent other unrelated tissues from being embedded into the surgical stapler, especially the posterior vaginal wall of female patients. The position of the posterior vaginal wall should be confirmed before the stapler is fired. After the anastomosis is completed, it can be explored through the vagina;

5. After the anastomosis is completed, it is best to pass the "inflatable test" or inject methylene blue solution through the anus to check whether the anastomosis is complete, and check the anastomosis by digital examination after surgery.

6. During anastomosis, the overlapping of circular and linear stapler anastomotic lines should be avoided, otherwise it will cause poor blood supply at the anastomosis, and anastomotic leakage is prone to occur after operation. Avoid damage to the rectum and vaginal walls when using high-frequency electrocautery.

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