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Altmeier Surgery for Correction of Total Rectal Prolapse (rectal Procidence): Presentation of Results From a Coloproctology Referral Service

Year: 2024

Type: article

Abstract: Introduction Complete rectal prolapse is characterized by the protrusion of all layers of the rectum through the anus and is associated with the progressive loss of function of the pelvic floor structures. More common in women and the elderly, it presents risk factors such as vaginal childbirth, constipation, and pelvic muscle weakness. Surgical correction is required, and the perineal technique is one of the options. Among these is the Altemeier procedure, which involves rectosigmoidectomy with transanal resection of the full thickness of the prolapse and colo-anal anastomosis. Objective To evaluate the surgical outcomes of patients undergoing complete rectal prolapse correction via the perineal approach using the Altemeier technique and compare the results with the literature. Method Retrospective observational study analyzing medical records and actively searching for patients treated with the Altemeier procedure between March 2017 and May 2024. The results were compared to existing literature. Results A total of 19 patients were included, aged between 42 and 92 years, with 18 females and 1 male. All patients underwent the Altemeier procedure, and in 4 cases, the procedure was associated with anal cerclage (Tiercsh technique). The size of the prolapse ranged from 5 to 17 centimeters, and the average length of hospitalization was 4.26 days. Of the immediate postoperative complications, only 1 case involved an infection of the surgical wound (at the Tiercsh stitches), no dehiscence of the colo-anal anastomosis was observed, and 1 patient developed pulmonary thromboembolism. In terms of early complications (30 days), 1 patient developed mild incontinence, 8 experienced soiling, 6 had constipation, and 3 complained of mild pain. On late follow-up, ranging from 3 months to 8 years, no recurrences were observed, and 5 patients died from unrelated causes. Conclusion In this study, no severe complications or recurrences were observed using the Altemeier technique, which proves to be a good option for correcting complete rectal prolapse. These findings align with the literature, which also reports short hospitalization times and low morbidity. Publication History Article published online: 25 April 2025 © 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/) Thieme Revinter Publicações Ltda. Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

Source: Journal of Coloproctology

DOI: 10.1055/s-0045-1808745