title: Trans-obturator colonic suspension during Altemeier's operation for full-thickness rectal prolapse: preliminary results with a new technique.
abstract: OBJECTIVE
  With the aim of reducing recurrence after perineal surgery for full-thickness rectal prolapse, a new operation consisting of a trans-obturator colonic suspension during Altemeier's operation has been developed.
  
  
  METHODS
  Eighteen women with full-thickness rectal prolapse were examined clinically, with validated quality of life and continence scores, colonoscopy, anorectal manometry, anal EMG and sacral reflex latency. Ten had a newly diagnosed and eight a recurrent prolapse. The Altemeier operation was combined with a levatorplasty in all cases using two porcine collagen prostheses sutured to the descending colon and passed through the trans-obturator space bilaterally. The operation was completed by a manual or stapled colo-anal anastomosis. Clinical examination, with quality of life and continence scores, anorectal manometry, EMG and sacral reflex latency, was scheduled during follow up, with the recurrence of prolapse as the primary outcome measure.
  
  
  RESULTS
  There were no recurrences at 30 months. There was no mortality and no complications. All patients experienced significant improvement in quality of life and faecal continence scores (P<0.01). Surgery did not affect anorectal pressures or sacral reflex latencies.
  
  
  CONCLUSIONS
  The new technique appears to be relatively easy to perform and is complication free with no recurrence after a short period of follow up. A larger study with appropriate controls and longer follow up is now needed to assess its real effectiveness in reducing the risk of recurrence.
authors.affiliation: 1st Department of General Surgery, Fondazione I.R.C.C.S Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via F. Sforza, 35 20122 Milan, Italy. pboccasanta@policlinico.mi.it
authors.forename: P
authors.initials: P
authors.lastname: Boccasanta
authors.forename: M
authors.initials: M
authors.lastname: Venturi
authors.forename: M
authors.initials: M
authors.lastname: Spennacchio
authors.forename: G
authors.initials: G
authors.lastname: Fratus
authors.forename: L
authors.initials: L
authors.lastname: Despini
authors.forename: G
authors.initials: G
authors.lastname: Roviaro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000503:physiopathology / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000009:adverse effects; D016009:Chi-Square Distribution; D003106:Colon / Q000601:surgery*; D004576:Electromyography; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D008365:Manometry; D008875:Middle Aged; D011788:Quality of Life; D012005:Rectal Prolapse / Q000150:complications / Q000601:surgery*; D055502:Secondary Prevention; D018709:Statistics, Nonparametric; D053825:Suburethral Slings / Q000009:adverse effects