Skip to main content
Erschienen in: European Surgery 6/2013

01.12.2013 | Original Article

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

verfasst von: B. Dauser, MD, S. Ghaffari, MD, B. Salehi, MD, G. Loncsar, MD, F. Herbst, MD, FRCS

Erschienen in: European Surgery | Ausgabe 6/2013

Einloggen, um Zugang zu erhalten

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.
Literatur
1.
Zurück zum Zitat Rieder E, Whiteford MH. Transrectal natural orifice translumenal endoscopic surgery (NOTES) for colorectal resection. Colorectal Dis. 2011;13:51–4. PubMedCrossRef Rieder E, Whiteford MH. Transrectal natural orifice translumenal endoscopic surgery (NOTES) for colorectal resection. Colorectal Dis. 2011;13:51–4. PubMedCrossRef
2.
Zurück zum Zitat Auffret M. Un cas de procidence du gros intestin d’une longueur de 90 centimetres: operation par excision: double range de suture; mort. Prog Med. 1882;10:650–2. Auffret M. Un cas de procidence du gros intestin d’une longueur de 90 centimetres: operation par excision: double range de suture; mort. Prog Med. 1882;10:650–2.
3.
Zurück zum Zitat Thompson HR. Discussion on prolapse of the rectum. Proc R Soc Med. 1949;41:1011. Thompson HR. Discussion on prolapse of the rectum. Proc R Soc Med. 1949;41:1011.
4.
Zurück zum Zitat Cirocco WC. The Altemeier procedure for rectal prolapse: an operation for all ages. Dis Colon Rectum. 2010;53:1618–23. PubMedCrossRef Cirocco WC. The Altemeier procedure for rectal prolapse: an operation for all ages. Dis Colon Rectum. 2010;53:1618–23. PubMedCrossRef
5.
Zurück zum Zitat Altemeier WA, Hoxworth PI, Giuseffi J. Further experiences with the treatment of prolapse of the rectum. Surg Clin N Am. 1955;35:1437–47. Altemeier WA, Hoxworth PI, Giuseffi J. Further experiences with the treatment of prolapse of the rectum. Surg Clin N Am. 1955;35:1437–47.
6.
Zurück zum Zitat Altemeier WA, Culbertson WR, Schowengerdt C, Hunt J. Nineteen year’s experience with the one-stage perineal repair of rectal prolapse. Ann Surg. 1971;173:993–1001. PubMedCrossRef Altemeier WA, Culbertson WR, Schowengerdt C, Hunt J. Nineteen year’s experience with the one-stage perineal repair of rectal prolapse. Ann Surg. 1971;173:993–1001. PubMedCrossRef
7.
Zurück zum Zitat Johansen OB, Wexner SD, Daniel N, Nogueras JJ, Jagelman DG. Perineal rectosigmoidectomy in the elderly. Dis Colon Rectum. 1993;36:767–72. PubMedCrossRef Johansen OB, Wexner SD, Daniel N, Nogueras JJ, Jagelman DG. Perineal rectosigmoidectomy in the elderly. Dis Colon Rectum. 1993;36:767–72. PubMedCrossRef
8.
Zurück zum Zitat Deen KI, Grant E, Billingham C, Keighley MR. Abdominal resection rectopexy with pelvic floor repair versus perineal rectosigmoidectomy and pelvic floor repair for full-thickness rectal prolapse. Br J Surg. 1994;81:302–4. PubMedCrossRef Deen KI, Grant E, Billingham C, Keighley MR. Abdominal resection rectopexy with pelvic floor repair versus perineal rectosigmoidectomy and pelvic floor repair for full-thickness rectal prolapse. Br J Surg. 1994;81:302–4. PubMedCrossRef
9.
Zurück zum Zitat Agachan F, Reissman P, Pfeifer J, Weiss EG, Nogueras JJ, Wexner SD. Comparison of three perineal procedures for the treatment of rectal prolapse. South Med J. 1997;90:925–32. PubMedCrossRef Agachan F, Reissman P, Pfeifer J, Weiss EG, Nogueras JJ, Wexner SD. Comparison of three perineal procedures for the treatment of rectal prolapse. South Med J. 1997;90:925–32. PubMedCrossRef
10.
Zurück zum Zitat Takesue Y, Yokoyama T, Murakami Y, et al. The effectiveness of perineal rectosigmoidectomy for the treatment of rectal prolapse in elderly and high-risk patients. Surg Today. 1999;29:290–3. PubMedCrossRef Takesue Y, Yokoyama T, Murakami Y, et al. The effectiveness of perineal rectosigmoidectomy for the treatment of rectal prolapse in elderly and high-risk patients. Surg Today. 1999;29:290–3. PubMedCrossRef
11.
Zurück zum Zitat Yoshioka K, Ogunbiyi OA, Keighley MR. Pouch perineal rectosigmoidectomy gives better functional results than conventional rectosigmoidectomy in elderly patients with rectal prolapse. Br J Surg. 1998;85:1525–6. PubMedCrossRef Yoshioka K, Ogunbiyi OA, Keighley MR. Pouch perineal rectosigmoidectomy gives better functional results than conventional rectosigmoidectomy in elderly patients with rectal prolapse. Br J Surg. 1998;85:1525–6. PubMedCrossRef
12.
Zurück zum Zitat Kim DS, Tsang CB, Wong WD, Lowry AC, Goldberg SM, Madoff RD. Complete rectal prolapse: evolution of management and results. Dis Colon Rectum. 1999;42:460–6. PubMedCrossRef Kim DS, Tsang CB, Wong WD, Lowry AC, Goldberg SM, Madoff RD. Complete rectal prolapse: evolution of management and results. Dis Colon Rectum. 1999;42:460–6. PubMedCrossRef
13.
Zurück zum Zitat Kimmins MH, Evetts BK, Isler J, Billingham R. The Altemeier repair: outpatient treatment of rectal prolapse. Dis Colon Rect. 2001;44:565–70. CrossRef Kimmins MH, Evetts BK, Isler J, Billingham R. The Altemeier repair: outpatient treatment of rectal prolapse. Dis Colon Rect. 2001;44:565–70. CrossRef
14.
Zurück zum Zitat Zbar AP, Takashima S, Hasegawa T, Kitabayashi K. Perineal rectosigmoidectomy (Altemeier’s procedure): a review of physiology, technique and outcome. Tech Coloproctol. 2002;6:109–16. PubMedCrossRef Zbar AP, Takashima S, Hasegawa T, Kitabayashi K. Perineal rectosigmoidectomy (Altemeier’s procedure): a review of physiology, technique and outcome. Tech Coloproctol. 2002;6:109–16. PubMedCrossRef
15.
Zurück zum Zitat Sobrado CW, Kiss DR, Nahas SC, et al. Surgical treatment of rectal prolapse: experience and late results with 51 patients. Rev Hosp Clin Fac Med Sao Paulo. 2004;59:168–71. PubMedCrossRef Sobrado CW, Kiss DR, Nahas SC, et al. Surgical treatment of rectal prolapse: experience and late results with 51 patients. Rev Hosp Clin Fac Med Sao Paulo. 2004;59:168–71. PubMedCrossRef
16.
Zurück zum Zitat Chun SW, Pikarsky AJ, You SY, et al. Perineal rectosigmoidectomy for rectal prolapse: role of levatorplasty. Tech Coloproctol. 2004;8:3–8. PubMedCrossRef Chun SW, Pikarsky AJ, You SY, et al. Perineal rectosigmoidectomy for rectal prolapse: role of levatorplasty. Tech Coloproctol. 2004;8:3–8. PubMedCrossRef
17.
Zurück zum Zitat Boccasanta P, Venturi M, Barbieri S, Roviaro G. Impact of new technologies on the clinical and functional outcome of Altemeier’s procedure: a randomized, controlled trial. Dis Colon Rectum. 2006;49:652–60. PubMedCrossRef Boccasanta P, Venturi M, Barbieri S, Roviaro G. Impact of new technologies on the clinical and functional outcome of Altemeier’s procedure: a randomized, controlled trial. Dis Colon Rectum. 2006;49:652–60. PubMedCrossRef
18.
Zurück zum Zitat Glasgow SC, Birnbaum EH, Kodner IJ, Fleshman JW Jr, Dietz DW. Recurrence and quality of life following perineal proctectomy for rectal prolapse. J Gastrointest Surg. 2008;12:1446–51. PubMedCrossRef Glasgow SC, Birnbaum EH, Kodner IJ, Fleshman JW Jr, Dietz DW. Recurrence and quality of life following perineal proctectomy for rectal prolapse. J Gastrointest Surg. 2008;12:1446–51. PubMedCrossRef
19.
Zurück zum Zitat Altomare DF, Binda G, Ganio E, De Nardi P, Giamundo P, Pescatori M. Long-term outcome of Altemeier’s procedure for rectal prolapse. Dis Colon Rectum. 2009;52:698–703. PubMedCrossRef Altomare DF, Binda G, Ganio E, De Nardi P, Giamundo P, Pescatori M. Long-term outcome of Altemeier’s procedure for rectal prolapse. Dis Colon Rectum. 2009;52:698–703. PubMedCrossRef
20.
Zurück zum Zitat Kim M, Reibetanz J, Boenicke L, Germer CT, Jayne D, Isbert S. Quality of life after transperineal rectosigmoidectomy. Br J Surg. 2010;97:269–72. PubMedCrossRef Kim M, Reibetanz J, Boenicke L, Germer CT, Jayne D, Isbert S. Quality of life after transperineal rectosigmoidectomy. Br J Surg. 2010;97:269–72. PubMedCrossRef
21.
Zurück zum Zitat Lee SH, Lakhtaria P, Canedo J, Lee YS, Wexner SD. Outcome of laparoscopic rectopexy versus perineal rectosigmoidectomy for full-thickness rectal prolapse in elderly patients. Surg Endosc. 2011;25:2699–702. PubMedCrossRef Lee SH, Lakhtaria P, Canedo J, Lee YS, Wexner SD. Outcome of laparoscopic rectopexy versus perineal rectosigmoidectomy for full-thickness rectal prolapse in elderly patients. Surg Endosc. 2011;25:2699–702. PubMedCrossRef
22.
Zurück zum Zitat Boccasanta P, Venturi M, Spennacchio M, Fratus G, Despini L, Roviaro G. Trans-obturator colonic suspension during Altemeier’s operation for full-thickness rectal prolapse: preliminary results with a new technique. Colorectal Dis. 2012;14:616–22. PubMedCrossRef Boccasanta P, Venturi M, Spennacchio M, Fratus G, Despini L, Roviaro G. Trans-obturator colonic suspension during Altemeier’s operation for full-thickness rectal prolapse: preliminary results with a new technique. Colorectal Dis. 2012;14:616–22. PubMedCrossRef
23.
Zurück zum Zitat Ris F, Colin JF, Chilcott M, Remue C, Jamart J, Kartheuser A. Altemeier’s procedure for rectal prolapse: analysis of long-term outcome in 60 patients. Colorectal Dis. 2012;14:1106–11. PubMedCrossRef Ris F, Colin JF, Chilcott M, Remue C, Jamart J, Kartheuser A. Altemeier’s procedure for rectal prolapse: analysis of long-term outcome in 60 patients. Colorectal Dis. 2012;14:1106–11. PubMedCrossRef
24.
Zurück zum Zitat Ding JH, Canedo J, Lee SH, Kalaskar SN, Rosen L, Wexner SD. Perineal rectosigmoidectomy for primary and recurrent rectal prolapse: are the results comparable the second time? Dis Colon Rectum. 2012;55:666–70. PubMedCrossRef Ding JH, Canedo J, Lee SH, Kalaskar SN, Rosen L, Wexner SD. Perineal rectosigmoidectomy for primary and recurrent rectal prolapse: are the results comparable the second time? Dis Colon Rectum. 2012;55:666–70. PubMedCrossRef
25.
Zurück zum Zitat Tsunoda A, Yasuda N, Yokoyama N, Kamiyama G, Kusano M. Delorme’s procedure for rectal prolapse: clinical and physiological analysis. Dis Colon Rectum. 2003;46:1260–65. PubMedCrossRef Tsunoda A, Yasuda N, Yokoyama N, Kamiyama G, Kusano M. Delorme’s procedure for rectal prolapse: clinical and physiological analysis. Dis Colon Rectum. 2003;46:1260–65. PubMedCrossRef
26.
Zurück zum Zitat Marchal F, Bresler L, Ayav A, et al. Long-term results of Delorme’s procedure and Orr-Loygue rectopexy to treat complete rectal prolapse. Dis Colon Rectum. 2005;48:1785–90. PubMedCrossRef Marchal F, Bresler L, Ayav A, et al. Long-term results of Delorme’s procedure and Orr-Loygue rectopexy to treat complete rectal prolapse. Dis Colon Rectum. 2005;48:1785–90. PubMedCrossRef
27.
Zurück zum Zitat Lieberth M, Kondylis LA, Reilly JC, Kondylis P. The Delorme repair for full-thickness rectal prolapse: a retrospective review. Am J Surg. 2009;197:418–23. PubMedCrossRef Lieberth M, Kondylis LA, Reilly JC, Kondylis P. The Delorme repair for full-thickness rectal prolapse: a retrospective review. Am J Surg. 2009;197:418–23. PubMedCrossRef
28.
Zurück zum Zitat Madiba TE, Baig MK, Wexner SD. Surgical management of rectal prolapse. Arch Surg. 2005;140:63–73. PubMedCrossRef Madiba TE, Baig MK, Wexner SD. Surgical management of rectal prolapse. Arch Surg. 2005;140:63–73. PubMedCrossRef
29.
Zurück zum Zitat Riansuwan W, Hull T, Bast J, Hammel JP, Church JM. Comparison of perineal operations with abdominal operations for full-thickness rectal prolapse. World J Surg. 2010;34:1116–22. PubMedCrossRef Riansuwan W, Hull T, Bast J, Hammel JP, Church JM. Comparison of perineal operations with abdominal operations for full-thickness rectal prolapse. World J Surg. 2010;34:1116–22. PubMedCrossRef
30.
Zurück zum Zitat Xiao L, Zhang WB, Jiang PC, et al. Can transanal tube placement after anterior resection for rectal carcinoma reduce anastomotic leakage rate? A single-institutional prospective randomized study. World J Surg. 2011;35:1367–77. PubMedCrossRef Xiao L, Zhang WB, Jiang PC, et al. Can transanal tube placement after anterior resection for rectal carcinoma reduce anastomotic leakage rate? A single-institutional prospective randomized study. World J Surg. 2011;35:1367–77. PubMedCrossRef
31.
Zurück zum Zitat Zhao WT, Hu FL, Li YY, Li HJ, Luo WM, Sun F. Use of a transanal drainage tube for prevention of anastomotic leakage and bleeding after anterior resection for rectal cancer. World J Surg. 2013;37:227–32. PubMedCrossRef Zhao WT, Hu FL, Li YY, Li HJ, Luo WM, Sun F. Use of a transanal drainage tube for prevention of anastomotic leakage and bleeding after anterior resection for rectal cancer. World J Surg. 2013;37:227–32. PubMedCrossRef
32.
Zurück zum Zitat Ito M, Sugito M, Kobayashi A, Nishizawa Y, Tsunoda Y, Saito N. Relationship between multiple numbers of stapler firings during rectal division and anastomotic leakage after laparoscopic rectal resection. Int J Colorectal Dis. 2008;23:703–7. PubMedCrossRef Ito M, Sugito M, Kobayashi A, Nishizawa Y, Tsunoda Y, Saito N. Relationship between multiple numbers of stapler firings during rectal division and anastomotic leakage after laparoscopic rectal resection. Int J Colorectal Dis. 2008;23:703–7. PubMedCrossRef
33.
Zurück zum Zitat Kim JS, Cho SY, Min BS, Kim NK. Risk factor for anastomotic leakage after laparoscopic intracorporeal colorectal anastomosis with a double stapling technique. J Am Coll Surg. 2009;209:694–701. PubMedCrossRef Kim JS, Cho SY, Min BS, Kim NK. Risk factor for anastomotic leakage after laparoscopic intracorporeal colorectal anastomosis with a double stapling technique. J Am Coll Surg. 2009;209:694–701. PubMedCrossRef
34.
Zurück zum Zitat Matthiessen P, Hallböök O, Andersson M, Rutegard J, Sjödahl R. Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis. 2004;6:462–9. PubMedCrossRef Matthiessen P, Hallböök O, Andersson M, Rutegard J, Sjödahl R. Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis. 2004;6:462–9. PubMedCrossRef
35.
Zurück zum Zitat Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M. Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg. 1998;85:355–8. PubMedCrossRef Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M. Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg. 1998;85:355–8. PubMedCrossRef
36.
Zurück zum Zitat Jestin P, Pahlman L, Gunnarsson U. Risk factors for anastomotic leakage after rectal cancer surgery: a case-control study. Colorectal Dis. 2008;10:715–21. PubMedCrossRef Jestin P, Pahlman L, Gunnarsson U. Risk factors for anastomotic leakage after rectal cancer surgery: a case-control study. Colorectal Dis. 2008;10:715–21. PubMedCrossRef
Metadaten
Titel
Altemeier’s procedure for complete rectal prolapse in elderly and frail patients: should we be afraid of?
verfasst von
B. Dauser, MD
S. Ghaffari, MD
B. Salehi, MD
G. Loncsar, MD
F. Herbst, MD, FRCS
Publikationsdatum
01.12.2013
Verlag
Springer Vienna
Erschienen in
European Surgery / Ausgabe 6/2013
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-013-0236-6

Weitere Artikel der Ausgabe 6/2013

European Surgery 6/2013 Zur Ausgabe