Apex Technique in the Treatment of Obstructed Defecation Syndrome Associated With Rectal Intussusception and Full Rectal Mucosa Prolapse

• Published in: Diseases of the colon & rectum Vol. 57; no. 11; pp. 1324 - 1328
• Main Authors: Regadas, F. Sergio P, Abedrapo, Mario, Cruz, Jose Vinicius, Murad Regadas, Sthela M, Regadas Filho, F. Sergio P
• Format: Journal Article
• Language: English
• Published: United States The American Society of Colon and Rectal Surgeons 01.11.2014
• Subjects: Adult; Aged; Brazil; Constipation - etiology; Constipation - pathology; Constipation - surgery; Female; Humans; Intussusception - complications; Intussusception - pathology; Intussusception - surgery; Male; Middle Aged; Rectal Prolapse - complications; Rectal Prolapse - pathology; Rectal Prolapse - surgery; Retrospective Studies; Surgical Stapling - methods; Syndrome; Treatment Outcome; Brazil
• ISSN: 0012-3706; 1530-0358
• DOI: 10.1097/DCR.0000000000000229

BACKGROUND:The aim of the current study was to demonstrate the use of a modified stapling technique, called the apex technique, to treat rectal intussusception and full rectal mucosal prolapse. It was conducted as a retrospective study at 3 centers (2 in Brazil and 1 in Chile). TECHNIQUE:The apex technique is performed by using a HEM/EEA-33 stapler. A pursestring suture is placed at the apex of the prolapse, on the 4 quadrants, independent of the distance to the dentate line. A second pursestring is then placed to define the band of rectal mucosa to be symmetrically resected. MAIN OUTCOME MEASURES:Outcome measures included width of the resected full-thickness rectal wall; the intensity of postoperative pain on a visual analog scale from 1 to 10; full mucosal prolapse and rectal intussusception assessed by physical examination, cinedefecography, or echodefecography; and change in the constipation scale. RESULTS:Forty-five patients (30 women/15 men; mean age, 59.5 years) with rectal intussusception and full mucosal prolapse were included. The median operative time was 17 (range, 15–30) minutes. Bleeding after stapler fire requiring manual suture occurred in 3 patients (6.7%); 25 (55.6%) patients reported having no postoperative pain. Hospital stay was 24 hours. The mean width of the resected rectal wall was 5.9 (range, 5.0–7.5) cm. Stricture at the staple line was seen in 4 patients, of whom 1 required dilation under anesthesia. The median follow-up time was 120 (range, 90–120) days. A small residual prolapse was identified in 6 (13.3%) patients. Imaging demonstrated complete disappearance of rectal intussusception in all patients, and the mean postoperative constipation score decreased from 13 (range, 8–15) to 5 (range, 3–7). CONCLUSIONS:The apex technique appears to be a safe, quickly performed, and low-cost method for the treatment of rectal intussusception. In this series, imaging examinations showed the disappearance of rectal intussusception, and a significant decrease in constipation score suggested improvement in functional outcomes.