title: Long-term outcome of perineal rectosigmoidectomy for rectal prolapse.
abstract: BACKGROUND
  Rectal prolapse is a disabling condition that often affects older patients with multiple comorbidities making complex surgeries impossible to perform.
  
  
  METHODS
  A retrospective review of patients who underwent perineal rectosigmoidectomy (Altemeier procedure) for rectal prolapse from January 1999 to March 2015 was performed in a Reference Hospital, being evaluated complications and surgery recurrence.
  
  
  RESULTS
  Thirty-six Altemeier procedures were performed in 33 patients during the study. Twenty-five (76.8%) were women and the mean age was 67 (range 31-91) years. The mean duration of rectal prolapse symptoms was 7.8 years; other complaints were: pain, bleeding, mucus discharge, constipation and fecal incontinence. The mean operative time was 134.8 min and the blood loss was little. The mean postoperative length of hospital stay was 3.9 days. There was no mortality. Early postoperative complications occurred in 3 (9.1%).
  
  
  METHODS
  an acute pulmonary edema, an urinary infection and a surgical site infection with partial anastomotic leak. This patient developed anastomotic stenosis requiring dilatation. The recurrence rate was 26.7% (8 patients), with a mean follow-up of 50 months, and three of them were treated with repeat Altemeier repair. Many patients complain of some degree of fecal incontinence, but all reported improvement in their quality of life after surgery.
  
  
  CONCLUSIONS
  The Altemeier procedure showed low morbidity but it was associated with significant recurrence rate. The same procedure can be repeated in case of recurrence with satisfactory results.
authors.affiliation: Colorectal Surgery Resident, Department of Surgery, University of Campinas (UNICAMP), Brazil.
authors.forename: Lílian Vital
authors.initials: LV
authors.lastname: Pinheiro
authors.affiliation: Department of Surgery, Colorectal Surgery Unit, University of Campinas (UNICAMP), Brazil.
authors.forename: Raquel Franco
authors.initials: RF
authors.lastname: Leal
authors.affiliation: Department of Surgery, Colorectal Surgery Unit, University of Campinas (UNICAMP), Brazil.
authors.forename: Cláudio Saddy Rodrigues
authors.initials: CS
authors.lastname: Coy
authors.affiliation: Department of Surgery, Colorectal Surgery Unit, University of Campinas (UNICAMP), Brazil.
authors.forename: João José
authors.initials: JJ
authors.lastname: Fagundes
authors.affiliation: Department of Surgery, Colorectal Surgery Unit, University of Campinas (UNICAMP), Brazil.
authors.forename: Carlos Augusto Real
authors.initials: CA
authors.lastname: Martinez
authors.affiliation: Department of Surgery, Colorectal Surgery Unit, University of Campinas (UNICAMP), Brazil. Electronic address: luayrizono@terra.com.br.
authors.forename: Maria de Lourdes Setsuko
authors.initials: Mde L
authors.lastname: Ayrizono
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D012809:Colon, Sigmoid / Q000601:surgery; D003248:Constipation / Q000209:etiology; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010502:Perineum / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011184:Postoperative Period; D011788:Quality of Life; D012005:Rectal Prolapse / Q000150:complications / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D013995:Time; D016896:Treatment Outcome
keywords: Altemeier procedure; Perineal rectosigmoidectomy; Procidentia; Rectal prolapse