Long-term outcome of Altemeier's procedure for rectal prolapse.
BACKGROUND
Altemeier's procedure is infrequently applied in European countries and because of the small number of patients treated in each center, its long-term reliability is uncertain.


METHODS
Medical records of 93 patients (median age, 77 years) undergoing perineal rectosigmoidectomy associated with levatorplasty in 72 patients (78 percent) were reviewed; 65 patients (70 percent) suffered from major fecal incontinence.


RESULTS
There was no postoperative mortality. Eight (8.6 percent) major complications were observed (3 pelvic hematomas, 1 anastomotic dehiscence, 1 sigmoid perforation, 1 pararectal abscess, and 2 late anal strictures), and 13 (14 percent) minor complications. At a mean follow-up of 41 (range, 12-112) months the complete recurrence rate was 18 percent (17 patients); these patients were treated with a repeat Altemeier's procedure (6 patients), Delorme's operation (1 patient), Wells' rectopexy (1 patient), postanal repair (1 patient), anal bulking agents (2 patients), and sacral nerve stimulation (2 patients). Anal manometry significantly improved postoperatively. Incontinence improved postoperatively in 30 cases (28 percent), deteriorated in 2 patients, while 4 patients developed minor incontinence.


CONCLUSIONS
Perineal rectosigmoidectomy for rectal prolapse is a relatively safe and effective treatment, in particular, for frail, older patients, with a low postoperative morbidity, but the recurrence rate is not negligible and restoration of continence is unpredictable.
Altomare
Donato F
DF
Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy. altomare@clichiru.uniba.it
Binda
GianAndrea
G
Ganio
Ezio
E
De Nardi
Paola
P
Giamundo
Paolo
P
Pescatori
Mario
M
D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D012809:Colon, Sigmoid / Q000601:surgery; D015897:Comorbidity; D003248:Constipation / Q000209:etiology; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008365:Manometry; D012005:Rectal Prolapse / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D016896:Treatment Outcome