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01.12.2013 | Original Article | Ausgabe 6/2013

European Surgery 6/2013

Altemeier’s procedure for complete rectal prolapse in elderly and frail patients: should we be afraid of?

Zeitschrift:
European Surgery > Ausgabe 6/2013
Autoren:
MD B. Dauser, MD S. Ghaffari, MD B. Salehi, MD G. Loncsar, MD, FRCS F. Herbst

Summary

Background

Complete rectal prolapse is more common in the elderly, with considerable effects on patient’s quality of life. Whenever co-existing morbidities render abdominal procedures impossible, perineal rectosigmoidectomy combined with levatorplasty as described by Altemeier is a viable option. However, performing a coloanal anastomosis without fecal diversion bears the risk of life-threatening (anastomotic) complications. We present our experience performing Altemeier’s procedure (AP) in a series of old and frail patients, and a review of literature.

Methods

Demographic, perioperative and postoperative data of patients undergoing AP for complete rectal prolapse between January 2008 and April 2013 were analysed retrospectively. In addition, we reviewed the literature in regard to anastomotic complications, morbidity and mortality after AP.

Results

In total, 16 (15 female) patients with a median age of 84.6 (range: 75–94) years underwent AP within the study period. American Society of Anaesthesiologists (ASA) score was I, II and III in four, six and six cases, respectively. General (n = 12), spinal (n = 3) or local (n = 1) anaesthesia was applied according to anaesthetist’s decision. No anastomotic leak was seen, and no patient died perioperatively. Minor complications were observed in three patients (18.8 %). According to the reviewed literature, overall anastomotic leak rate, morbidity and mortality after AP have been 2.7, 12.1 and 0.5 %, respectively (median values).

Conclusions

AP proved to be a safe repair for complete rectal prolapse in the elderly.

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