title: Recurrence after perineal rectosigmoidectomy: when and why?
abstract: OBJECTIVE
  Reported recurrence rates after perineal rectosigmoidectomy (Altemeier's procedure) in patients with full-thickness rectal prolapse vary from 0% to 60%. The object of this study was to analyse risk factors for recurrence after this procedure.
  
  
  METHODS
  From May 2004 to December 2012, 63 consecutive patients suffering from full-thickness rectal prolapse undergoing perineal rectosigmoidectomy were included. Of these 46 were female and the median age of the whole group was 79 (30-90) years. The median follow-up was 53 (3-99) months. Patient characteristics and operative parameters were compared between patients with and without recurrence.
  
  
  RESULTS
  One patient died and another patient needed re-operation. Eight full-thickness recurrences occurred in eight patients after a median of 18 (6-48) months. Stapled compared with handsewn anastomosis (hazard ratio 7.96, 95% confidence interval 1.90-33.47; P = 0.001) and shorter specimen length (hazard ratio 4.06, 95% confidence interval 0.97-16.99; P = 0.03) increased the risk of recurrence in Cox regression analysis.
  
  
  CONCLUSIONS
  The operative technique including stapled anastomosis and length of the resected specimen seems to be associated with a high recurrence rate after perineal rectosigmoidectomy.
authors.affiliation: Department of General, Gastrointestinal, Vascular and Paediatric Surgery, University Hospital Wuerzburg, Wuerzburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Kim
authors.forename: J
authors.initials: J
authors.lastname: Reibetanz
authors.forename: N
authors.initials: N
authors.lastname: Schlegel
authors.forename: K
authors.initials: K
authors.lastname: Krajinovic
authors.forename: H
authors.initials: H
authors.lastname: Köstler
authors.forename: C-T
authors.initials: CT
authors.lastname: Germer
authors.forename: C
authors.initials: C
authors.lastname: Isbert
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods*; D012809:Colon, Sigmoid / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000601:surgery*; D016016:Proportional Hazards Models; D012005:Rectal Prolapse / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Altemeier's procedure; External rectal prolapse; recurrence