Altemeier's procedure (rectosigmoidectomy) for rectal prolapse

General information

• Rectal prolapse is associated with feacal incontinence in about 50-70%
• Mucosal prolapse should be distinguished from a rectal prolapse. A careful examination during straining should be performed
• The aim of the treatment is to control the prolapse and to restore continence
• Rectopexy is the treatment of choice for rectal prolapse. Those abdominal repairs involve fixing the rectum to the sacrum by using either mesh or sutures, and tend to have the lowest recurrence rates (<10%)
• Perineal surgical repairs are well tolerated, but are generally associated with higher recurrence rates
• The Altemeier procedure can be considered for elderly patients who are most likely unfit for a major abdominal procedure (e.g. rectopexy)
• The perineal approach for an Altemeier's procedure also creates the possibility to repair the pelvic floor muscles when necessary
• Recurrence rates for the Altemeier's procedure vary from 3 to 43%

Literature
1. Treatment of extensive prolapse of the rectum in aged or debilitated patients. Altemeier WA et al et al. AMA Arch Surg. 1952 Jul;65(1):72-80
2. Surgical management of rectal prolapse. Marderstein EL et al. Nat Clin Pract Gastroenterol Hepatol. 2007 Oct;4(10):552-61.
3. Abdominal resection rectopexy with pelvic floor repair versus perineal rectosigmoidectomy and pelvic floor repair for full-thickness rectal prolapse. Deen KI, Grant E, Billingham C, Keighley MR. Br J Surg. 1994 Feb;81(2):302-4.