The Altemeier Procedure for Rectal Prolapse: An Operation for All Ages

Abstract

Perineal rectosigmoidectomy was the most popular operation performed for rectal prolapse in the first half of the 20th century. However, high recurrence rates relegated it to a back-up role for elderly or other high-risk patients who were not candidates for an abdominal operation. Recent series (combined with levatorplasty = Altemeier procedure) revealed excellent results across a broader spectrum of patients and inspired this ongoing consecutive series of cases. This is a review of 103 (99 women) consecutive patients (mean age, 68.9 y; range, 20-97 y) who underwent the Altemeier procedure between 2000 and 2009. Patients were placed in the prone jackknife position: 93 patients (90%) with the use of general anesthesia and 10 patients (10%) with the use of spinal anesthesia. The mean follow-up was 43 months (range, 3 mo to 10 y). The mean time for the operation was 97.7 minutes (range, 50-180 min) with a mean 7.2 cm of rectum resected (range, 2.5-26.7 cm). The mean blood loss was 66.9 mL (range, 0-350 mL). The mean time to tolerating a diet was 2.3 days (100% within 4 d) and mean postoperative length of hospital stay was 4.2 days (93% within 6 d). There was no mortality, minimal morbidity (14%), and no recurrence. Preoperative constipation (61% of patients) improved in 94% and preoperative fecal incontinence (47% of patients) improved in 85%, whereas 15% developed new onset of seepage or incontinence to flatus. The Altemeier procedure for rectal prolapse provided excellent results across all age groups with minimal morbidity, allowing for short hospital stays and periods of convalescence. To this point, there has been no evidence of recurrence in this group of patients, pending longer periods of follow-up, especially among patients from the younger age groups.