The Altemeier Procedure for Rectal Prolapse: An Operation for All Ages

Abstract

The Altemeier procedure for rectal prolapse provided excellent results across all age groups with minimal morbidity, allowing for short hospital stays and periods of convalescence. To this point, there has been no evidence of recurrence in this group of patients, pending longer periods of follow-up, especially among patients from the younger age groups.

Altemeier Operation for Recurred and Strangulated Rectal Prolapse

“…Delorme's technique is difficult because of the presence of edema and is contra-indicated in case of necrosis. With Altemeier operation, the immediate postoperative morbidity is low with an anastomotic leakage risk practically nil [4,5]. In the long term, the recurrence rate is acceptable (14-16 %), regardless of the length of resection and the addition of levatorplasty, although it is still higher than abdominal approaches [4,5].…”

“…With Altemeier operation, the immediate postoperative morbidity is low with an anastomotic leakage risk practically nil [4,5]. In the long term, the recurrence rate is acceptable (14-16 %), regardless of the length of resection and the addition of levatorplasty, although it is still higher than abdominal approaches [4,5]. Improvement of continence is achieved in 62-85 % [4,5]; the addition of levatorplasty would provide better results [3].…”

Explaining the undulating outcomes of perineal rectosigmoidectomy (Altemeier Procedure) for rectal prolapse over the last century: technique matters!

“…In the past decade, excellent outcomes reported in many countries (Japan, Brazil, Germany, Italy and the USA) spanning several continents have forced a re-evaluation and resurgence of PR as a viable treatment option, especially for the typical patient population of elderly women [6][7][8][9]. Given the recent low rates of recurrence following PR of the past few decades, some centers have even suggested PR for all patients suffering from rectal prolapse, regardless of age [6,9].…”

“…Given the recent low rates of recurrence following PR of the past few decades, some centers have even suggested PR for all patients suffering from rectal prolapse, regardless of age [6,9].…”

“…Furthermore, PSPR does not allow access for levatorplasty which defines the Altemeier Procedure and separates it from mere amputation of the rectum (PR). Some authors note that levatorplasty is easily performed during PR and results in low rates of recurrence with a beneficial effect on postoperative fecal continence [9,13].…”