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Altemeier's procedure, Step by step
- Place patient in lithotomy position (or in prone jack-knife position)
- Prolapse should be delivered on to the perineum
- The mucosa is divided transversely at the dentate line
- While dividing the muscle layer, the submucosal vessels should be carefully cauterized
- The rectum is then withdrawn to expose the rectovaginal peritoneal pouch
- The peritoneum should be opened anteriorly and lateraly and the sigmoid colon can now be exposed
- Posterior transection of the rectum can be completed
- Mesorectum is divided and ligated
- Sigmoid colon is pulled down and the transection site can be determined
- Sigmoid mesentery is divided and ligated
- The anterior aspect of the sigmoid colon is opened
- Now the first (i.e. anterior) anastomotic suture can be placed
- The lateral aspect of the sigmoid colon is opened and the lateral anastomotic sutures can be placed
- Transection of the sigmoid colon can then be completed
- The coloanal anastomosis can now be completed with a total of about eight sutures
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