2015;(11). 2006;30:659–63. Major complications were not related to the ASA score, BMI or age [average age … | 30 days morbidity according to Clavien-Dindo classification [4] and 30 days mortality were recorded. The aim of surgical repair is to remove the prolapse, with the additional hope of restoring continence and relieve any evacuation difficulty with minimal morbidity and mortality [2, 21]. At follow-up any change in pelvic floor function and recurrences were determined. 2). Data on 43 consecutive female patients undergoing Altemeier’s procedure for complete rectal prolapse were reviewed. Perineal rectosigmoidectomy for primary and recurrent rectal prolapse: are the results comparable the second time? Significant, Unavoidable And Frequently Occurring Risks After Altemeier’s Procedure The Altemeier’s procedure is generally a very safe operation with few risks but, as with any surgical procedure, complications do occasionally occur; fewer than 5% patients need to have a second anaesthetic to attend to a complication. (XLSX 20 kb). WHAT ARE THE SPECIFIC RISKS INVOLVED? Each female had had a mean of 1.4 deliveries. Major complication occurred in only one patient that was pneumonia with lung failure. The surgical technique including the addition of levatorplasty to the rectosigmoidectomy, duration of the operation, the length of resected bowel, the interval from operation to the first bowel movement and the length of hospital stay were all recorded. Laparoscopic anterior rectopexy to the promontory for full-thickness rectal prolapse in 175 consecutive patients short- and long-term follow-up. who found no association between the length of the resected bowel and recurrence [13]. Interestingly, levatorplasty offered an improvement in the ODS score while hadn’t any discernable effect on Vaizey score. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Introduction: Williams JG, Rothenberger DA, Madoff RD, et al. 2004;240(2):205–13. Long term, this procedure has been associated with higher recurrence rates than what has been reported with abdominal types of repair [5,6]. There was no statistically significant difference in the Vaizey score before and after surgery (p = 1.000) (Fig. 2021 Feb 6;9(4):847-853. doi: 10.12998/wjcc.v9.i4.847. 2013;15(7):858–68. 2015;29(3):607–13. reported average loss of 20 ml and Cirocco, 66.9 ml. | The average duration of symptoms was 2 years. Gallo G, Martellucci J, Pellino G, Ghiselli R, Infantino A, Pucciani F, Trompetto M. Tech Coloproctol. 2012;55(6):666–70. The mean preoperative scores for constipation and incontinence, the ICIQ SF score and preoperative residual urinary volume score are given in Table 1. However, multiple recurrences following surgical repair for RP is a critical problem in RP surgery. Moreover, a recent Cochrane review failed to confirm the superiority of transabdominal over perineal procedures, due to the heterogeneity and poor quality of the available studies [31]. The overall median decrease in ODS score was 1.5. Prevention and treatment information (HHS). Gastroenterol Clin Biol. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Kairaluoma MV, Kellokumpu IH. 2012;14(3):362–8. Borgaonkar VD, Deshpande SS, Borgaonkar VV, Rathod MD. RESULTS: Post-operative complications at 30 days occurred in 18 patients (38%). Nineteen years’ experience with the one-stage perineal repair of rectal prolapse. Three patients experienced a worsening and in ten there was no change. In contrast, perineal procedures—as typified by the Altemeier and Delorme procedures—have been performed widely because of its lower operative morbidity rate and good recovery after surgery for frail elderly patients with comorbidities . S Rita Clinic, Vercelli, Italy, Mario Trompetto, Roberta Tutino, Alberto Realis Luc, Gaetano Gallo & Giuseppe Clerico, Dept. It offered improved evacuation in constipated patients while didn’t improve fecal and urinary continence. Google Scholar. Rectal procidentia in elderly and debilitated patients. volume 19, Article number: 1 (2019) WebMD explains laparoscopic proctosigmoidectomy, a surgery that removes a diseased section of the rectum and sigmoid colon if there is colorectal cancer. Epub 2016 Oct 26. Clipboard, Search History, and several other advanced features are temporarily unavailable. Levatorplasty is performed to correct elvator diastasis which is commonly associated with rectal prolapse. Abdominal approaches have been shown to be associated with lower rates of recurrence than perineal procedures after which rates of up to 58% have been reported [19, 23]. Recurrences in our series occurred in 35% of cases, with an estimated risk of at 48 months of 40% (Table 4) [10,11,12,13,14,15,16,17,18, 24,25,26,27,28,29,30]. Treatment of rectal prolapse. Wijffels N, Cunningham C, Dixon A, et al. 2012;14(9):1106–11. Post-operative complications at 30 days occurred in 18 patients (38%): these were classified as Clavien-Dindo grade 1 in 14 patients (78%), grade 2 in 3 patients (17%), grade 3 in zero, and grade 4 in only one patient (5%). Rectal prolapse: a 10-year experience. Kim M, Reibetanz J, Schlegel N, et al. Zbar AP, Takashima S, Hasegawa T, Kitabayashi K. Tech Coloproctol. Faucheron JL, Voirin D, Riboud R, et al. Mean follow-up for all patients was 1.5 years. Fleming et al. The choices can be broadly categorized into three types: (a) sigmoid resection with rectopexy (Frykman-Goldberg procedure), (b) rectopexy with or without mesh, and (c) perineal approaches including perineal rectosigmoidectomy (Altemeier procedure) or rectal mucosectomy and plication (Delorme procedure). 2016;27(1):33–9. Ochsner J. Written informed consent was obtained from the patients. Color Dis. CAS The score on patient’s satisfaction and the urinary retention score are not validated. In our study, 93.3% presented blood loss lower than 200 ml. NIH Gut. Dis Colon Rectum. General anesthesia was used in 18 (42%) patients and a spinal block in 25 (58%). They found that a perineal approach was independently associated with a lower 30-day major and minor complication rate than any abdominal procedure. At the same follow-up there were 12 (35%) cases of recurrence with an estimated risk at 48 months of 40%. 2015;19(9):521–5. Surgical options for full-thickness rectal prolapse: current status and institutional choice. There were no statistically significant differences between patients with and without recurrence regarding age (p = 0.188), BMI (p = 0.864), ASA score (p = 0.433), previously repaired prolapse (p = 0.398), previous hysterectomy (p = 0.705), length of resected bowel (p = 0.126), and levatorplasty (p = 0.304). PubMed Google Scholar. To this point, there has been no evidence of recurrence in this group of patients, pending longer periods of follow-up, … 2012 Sep;14(9):1106-11. doi: 10.1111/j.1463-1318.2011.02904.x. NLM No.:CD001758. METHODS: METHODS:Between February 1993 and December 1999, 63 patients (61 females) underwent Altemeier repair of rectal prolapse. Epub 2017 Dec 15. It offered improved evacuation in constipated patients while didn’t improve fecal and urinary continence. 2017;60(11):1121–31. Major complications were not related to the ASA score, BMI or age [average age … Xynos E. Functional results after surgery for overt rectal prolaps. 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. Please enable it to take advantage of the complete set of features! There was no mortality. The etiology is multifactorial and includes weakness of the pelvic floor, chronic constipation, multiple pregnancies, previous pelvic surgery and a deep pouch of Douglas [2]. The mean length of hospital stay was 6 [3–8] days. Gastroenterological options in faecal incontinence. Major complications were not related to the ASA score, BMI or age [average age 76.4]. It was retrospective and the follow up was not performed in all patients. 1983;26(12):789–91. Recurrence of prolapse was 40% at four years. PubMed Central https://doi.org/10.1186/s12893-018-0463-7, DOI: https://doi.org/10.1186/s12893-018-0463-7. 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. Epidemiologic aspects of complete rectal prolapse. In contrast the perineal approach which reduces rectal capacity and rectal wall compliance may increase the frequency of defecation, urgency and fecal incontinence in up to 40% of patients [21] with constipation reported in 10% [22]. 2004;8(1):3–9. It is also associated with a mixed pattern of functional disorders ranging from difficulty of evacuation of stool, so called obstructive defecation syndrome (ODS), to fecal incontinence. Seminars in Colon and Rectal Surgery WB Saunders. Tailored surgery for internal and external rectal prolapse: functional results of 268 patients operated upon by a single surgeon over a 21-year period*. MT, ARL and RT gave substantial contribution to the conception of the work. Bader AM. Madiba TE, Baig MK, Wexner SD. Tou S, Brown SR, Nelson RL. Female gender with possible obstetric trauma, the wider pelvis and weaker pelvic floor due to age and gender are factors that would contribute to poor function and the failure of repair of the prolapse to alter most of the functional scores indicates that the prolapse itself may not be an important factor in the bowel and urinary dysfunction often observed in patients with prolapse. One patient showed an improvement in urinary retention but in all other patients the score was unchanged (p = 1.000). 2010;53(12):1618–23. Tech Coloproctol. statement and Art. Educational step-by-step video provided by MovieSurg. Part of Br J Surg. This site needs JavaScript to work properly. Functional results analyzing bowel and urinary function patient satisfaction were investigated. This finding was in contrast to the findings of Ding et al. Ann Surg. There were no statistically significant differences between patients with and without recurrence regarding age (p = 0.188), BMI (p = 0.864), ASA score (p = 0.433), recurrent prolapse (p = 0.398), previous hysterectomy (p = 0.705), length of resected bowel (p = 0.126), and levatorplasty (p = 0.304) (Table 2). Chun SW, Pikarsky AJ, You SY, et al. Anal manometry significantly improved postoperatively. 2017 Feb;79(1):45-50. doi: 10.1007/s12262-016-1562-2. Authors declare they have no supportive foundations. Ris F, Colin JF, Chilcott M, et al. Endoanal ultrasound (EUS), contrast defecography, magnetic resonance imaging (MRI)- defecography, colonic motility and anorectal manometric studies were not routinely performed in all patients, usually owing to their advanced age and the obvious diagnosis of rectal prolapse on observation. Terms and Conditions, Major complication occurred in only one patient that was pneumonia with lung failure. Hoel AT, Skarstein A, Ovrebo KK. The present study evaluated the morbidity, mortality, function and recurrence rate in patients undergoing Altemeier’s operation for complete rectal prolapse. Rectal prolapse has an estimated incidence of 2.5/100000 of the general population. ARL, RT, GG and EN gave substantial contribution to the acquisition, analysis and interpretation of data. There was no difference in rates of minor complications. Advances in preoperative risk assessment and management. Clinical practice guidelines for the treatment of rectal prolapse. There was no postoperative mortality. Dr. William A. Altemeier . So, it could be an available option for frail patients with complete rectal prolapse. Thirty four patients were assessed at a median interval of 49 (2–135) months, six being deceased for reason not related to the prolapse and three lost to follow-up. Perineal rectosigmoidectomy for rectal prolapse: role of levatorplasty. 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. One additional child experienced recurrence after an initial Thiersch procedure, and underwent a perineal resection of redundant rectum (modified Altemeier procedure). Anal encirclement is no longer commonly performed; it … | The average BMI was 22,2 (± 4.4). There was statistically significant differences in the ODS score changes between the 21 patients who underwent a levatorplasty and the 13 who did not with a median of differences of 0 in the group without plasty and of − 2 in the group with plasty (p = 0.0156) while there were no differences in Vaizey score changes (p = 0.4524). There was a statistically significant decrease postoperatively in the median of the differences of 2.5 (p < 0.001) (Fig. Conclusions: Curr Probl Surg. Altemeier WA, Culbertson WR, Schowengerdt C, et al. © 2021 BioMed Central Ltd unless otherwise stated. Lee SH, Lakhtaria P, Canedo J, et al. 2018 Mar-Apr;31(2):188-197. doi: 10.20524/aog.2017.0220. Dis Colon Rectum. 2005;94(3):207–10. At long-term follow-up functional results demonstrate a statistically significant decrease in the Obstructive Defecation Syndrome (ODS) score, but no statistically significant changes in the Vaizey score, the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) score and the urinary retention score. Outcomes of rectal prolapse using the altemeier procedure. Set-up and statistical validation of a new scoring system for obstructed defaecation syndrome. Recovery will be different for everyone, and can be 4-6 weeks. Altemeier’s procedure can be carried out under spinal anesthesia, avoiding the trauma of a laparotomy and permitting rapid recovery of alimentary function and mobility. 2006 May;49(5):652-60. doi: 10.1007/s10350-006-0505-6. Dis Colon Rectum. Patient satisfaction was determined using a simple numerical scale from 0 (not satisfied) to 10 (completely satisfied). (Additional file 1). Methods: The aim of this retrospective study was to evaluate morbidity, mortality, postoperative function and recurrences in patients treated by Altemeier’s rectosigmoidectomy for complete rectal prolapse in a referral center for pelvic floor functional disorders. Complications from this procedure include obstruction with fecal impaction and erosion of the wire with infection. of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy, Department of Biostatistics, S.Gaudenzio Clinic, Policlinico di Monza, Italy, Department of General Surgery, University of Catanzaro, Catanzaro, Italy, You can also search for this author in Scand J Surg. These complications include the risk of infection, bleeding, pain, wound breakdown, deep vein thrombosis, or complications affecting the heart, lungs or kidneys. Surgical management of rectal prolapse. Epub 2018 Dec 15. Color Dis. Color Dis. This may be further supported by the finding in the present study of an improvement in the ODS which will give some symptomatic relief. Dis Colon Rectum. Recurrence of prolapse was 40% at four years. 2013;15(7):620. 2008;10(1):84–8. The Mann-Whitney U-Test was used to evaluate patient satisfaction regarding recurrence. 2016;20:695–700. Postoperative complication rate was 12% (n = 9) [Altemeier 5 (22%) vs. Delorme 4 (7%), p = 0.04]. Cite this article. 2005;27(5):414–9. Dis Colon Rectum. The relatively high number of recurrences after perineal repair should be balanced with the minimal invasiveness of the technique and the possibility of repeat it with no additional morbidity and considering the relatively long recurrence time. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 2014;16(11):920–4. In this article, the results of a series of 63 consecutive Altemeier repairs are presented. Furthermore functional outcomes (constipation, continence and outlet obstruction) after laparoscopic ventral rectopexy were at least equivalent as the ones after open abdominal or perineal procedures [36, 37]. Acta Chir Iugosl. Incontinence improved postoperatively in 30 cases (28 percent), deteriorated in 2 patients, while 4 patients developed minor incontinence. USA.gov. Correspondence to This exhibit represents some of the key work, moments, and achieve-ments of Dr. Altemeier’s life. Long term follow-up was performed in 34 available patients with three patients lost to follow up and six deceased for reasons related to their ages and comorbidity not related to the surgical procedure (they would have had at the time of long term follow-up an average age of 90 years old with a median of 91 years old) being excluded from the analysis. Altemeier's procedure for rectal prolapse: analysis of long-term outcome in 60 patients. Murad-Regadas SM, Pinto RA. Comparison between pre-operative and post-operative functional scores was performed using the paired t-test or Wilcoxon’s rank sum test for paired data. Continence was assessed pre and post-operatively using the Vaizey scoring system [6], which ranges from 0 (normal continence) to 24 (severe incontinence). They divided complications into minor and major, taking major complications to include organ space infection, cardiac and thromboembolic events, ventilator dependence, pneumonia, return to the operating room, renal failure and sepsis. The relatively high number of recurrences should be balanced with the minimal invasiveness of the technique and the possibility of repeating it with no additional morbidity and considering the relatively long recurrence time that in our cases was 17 months in mean with no deterioration in function. Demographic data including age, number and type of delivery, comorbidity, previous pelvic or perineal surgery, duration of symptoms, bowel function including frequency of defecation, urgency and incontinence, urinary function, body mass index (BMI) and American Society of Anesthesiologists (ASA) score were recorded.
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