The Small Bowel Stoma Also Accommodates The Application Of The Round Stapler And The Linear Cutting Stapler During The Operation And The Prevention Of Complications

ObjectiveSmall intestinal stoma closure operation is one of the common surgical techniques of general surgery,which is not complicated but has more complications.The objective of this study was to evaluate the application of circular stapler and linear cutting stapler in the small intestinal stoma closure operation,compare the differences of operation time,anus exhaust ti me,the incidence of postoperative complications,hospital stay and hospitalization expenses between the two groups by using different staplers in operation,learn the affecting factors of the two shapes of stapler for postoperative recovery,and analyze the related data of the patients and look up the past literatures to assist clinicians in learning these influences of postoperative recovery,thereby reduce the occurrence of postoperative complications.MethodsExperimental group:Review the clinical data of 65 patients who have been through the small intestinal stoma closure operation successfully by the use of different staplers in our hospital from April 2013 to November 2017,the patients were divided into two groups:circular stapler group(group A)and linear cutting stapler group(group B),33 cases in group A using circular stapler in end-to-side anastomosis under general anaesthetic,under the same anaesthetic 32 cases of group B using linear cutting stapler in side-to-side anastomosis.Observation indexes:Gathered the materials such as patients' age,gender,nutritional status,basicdiseases,reasons for enterostomy,operation time,special treatment in surgery,postoperative anal exhaust time,postoperative complications,postoperative management and so on,the differences between the two groups were found by comparing the operation time,anus exhaust time,the incidence of postoperative complications,hospital stay and hospitalization expenses.Results1.The operation time:The operation time in group B was 82.5±21.0 minutes,group A was 104.2 ± 25.7 minutes,compared with the group A,the length of time was significantly shorter in group B(P<0.05).2.The postoperative anal exhaust time:The postoperative anal exhaust time was 3.4±1.4 days in group A,group B was 2.8±0.7 days,compared with the group B,the time was later in group A(P<0.05).3.The hospital stay:The hospital stay of group A was 17.8±7.4 days,group B was 15.8±6.3 days,there were no significant differences between the two groups(P>0.05).4.The hospitalization expenses:The hospitalization expenses of group A were RMB 30390.7±9369.0 yuan,compared with group B there were RMB 25094.1±6043.9 yuan,which were significantly higher(P<0.05).5.The postoperative complications:There were 12 cases of postoperative complications in group A(including 1 case of anastomotic bleeding,1 case of anastomotic leakage,2 cases of abdominal cavity hemorrhage,2 cases of incomplete intestinal obstruction,2 cases of diarrhea,4 cases of wound infection),and there were 7 cases of postoperative complications in group B(including 2 cases of anastomotic bleeding,1 case of incomplete intestinal obstruction,1 case of abdominal remnant infection,1 case of diarrhea,2 cases of wound infection),there were no significant differences between the two groups(P>0.05).ConclusionThe application of two different staplers in the small intestinal stoma closure operation was safe and reliable,but the linear cutting stapler has its relatively unique advantages:the use of linear cutting stapler in operation is simple,surgeons do not need to separate too much mesentery around the stoma,which may shorten the operation time;the blood supply of the anastomotic site is not be limited because of few separation of mesentery,which may reduce the incidence rate of ischemic necrosis of intestinal anastomosis;it is not necessary for the operator to select the type of staplers according to the diameter of the intestinal tube,eliminating the subjective factor of the surgeon's empirical choice,which may avoid the anastomotic stenosis or anastomotic dehiscence for inappropriate choice;the diameter of the anastomosis can be freely adjusted and slightly wider than the diameter of the intestinal tubea to avoid the anastomotic stenosis because of anastomotic edema in the early and late-developed anastomotic scar,and to reduce the anastomotic tension for the passage of intestinal contents conveniently.The way of intestinal anastomosis is in accordance with the physiological function of the intestinal tract underwent linear cutting stapler,which is beneficial to the healing of the mucosa and the quick recovery of intestinal function.Linear cutting stapler has the function of cutting and anastomosis in an organic whole.By contrast,circular stapler just has the function of anastomosis,the closure of intestinal stump requires additional closing devices.If it is closed with manual intestinal anastomosis,the operation time will be prolonged,thus hospitalization expenses are relatively less by the use of linear cutting stapler and the economic burden of the patients can be reduced.No matter what kind of staplers the surgeons use,both of all need surgeons to manage the timing of operation,prepare well before surgery,including knowing and improving the factors of patients themselves that affect the recovery,detailed preoperative examination and evaluation,adequate bowel preparation.During the surgery the surgeons should operate carefully,detach the abdominal adhesions moderately,use the staplers accurately and normatively,work with the anesthesiologists to keep the patients' vital signs stable and ensure the perfusion of tissue.The surgeons should strengthen postoperative management of patients and avoid using medicines that affects healing,ensure nutrition support and nursing adequately to prevent the occurrence of postoperative complications in every way.