Altemeier%26apos;s procedure for rectal prolapse: analysis of long-term outcome in 60 patients

作者：Ris F; Colin J F; Chilcott M; Remue C; Jamart J; Kartheuser A^*

来源：Colorectal Disease, 2012, 14(9): 1106-1111.

DOI：10.1111/j.1463-1318.2011.02904.x

• Rectal prolapse
• Altemeier procedure
• perineal rectosigmoidectomy
• levatorplasty
• rectal compliance
• anal manometry

Aim Altemeiers procedure (perineal rectosigmoidectomy) is the operation of choice for rectal prolapse in the elderly. The aims of this prospective observational study were to evaluate its long-term actuarial recurrence risk and the influence of the length of rectosigmoid resection and associated levatorplasty on recurrence rate and continence. Method The perioperative and long-term data for all patients undergoing Altemeiers procedure since 1992 were analysed with regard to mortality, morbidity, continence, anorectal function and recurrence rate. Results Sixty patients [median age 77 years (3598)] underwent rectosigmoid resection [median length of bowel 14 (660) cm] with associated levatorplasty in 21 (35%). Overall mortality and morbidity were 1.6 and 11.6%, respectively. Manometry showed increased anal sphincter basal pressure and maximal squeeze pressure. We observed a decrease in postoperative rectal compliance (P = 0.002). Age, gender, prolapse duration before surgery, levatorplasty and length of resection had no statistically significant relationship with recurrence. Continence improved in 62% and was stable over a median follow-up of 48 (1186) months. Continence was positively related to a short length of bowel resection, but not to decreased rectal compliance. Actuarial recurrence was 14% at 4 years. Conclusion The long-term recurrence rate after the Altemeier procedure was low and not linked to resection length or to levatorplasty. Improvement in continence was stable over time.

• 出版日期2012-9