title: Apex technique in the treatment of obstructed defecation syndrome associated with rectal intussusception and full rectal mucosa prolapse.
abstract: 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).
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: 1School of Medicine, Federal University of Ceara and Hospital Sao Carlos, Fortaleza, Brazil 2Clinical Hospital, University of Chile, Santiago, Chile 3Santa Casa de Porto Alegre, Rio Grande do Sul, Brazil.
authors.forename: F Sergio P
authors.initials: FS
authors.lastname: Regadas
authors.forename: Mario
authors.initials: M
authors.lastname: Abedrapo
authors.forename: Jose Vinicius
authors.initials: JV
authors.lastname: Cruz
authors.forename: Sthela M
authors.initials: SM
authors.lastname: Murad Regadas
authors.forename: F Sergio P
authors.initials: FS
authors.lastname: Regadas Filho
mesh_terms: D000328:Adult; D000368:Aged; D001938:Brazil; D003248:Constipation / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007443:Intussusception / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012005:Rectal Prolapse / Q000150:complications / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000379:methods*; D013577:Syndrome; D016896:Treatment Outcome