The Altemeier repair: Outpatient treatment of rectal prolapse

PURPOSE: Rectal prolapse typically occurs in elderly patients, who are ofte n poor surgical candidates because of the presence of multiple comorbiditie s. Abdominal ap preaches to procidentia have low recurrence rates but are a ssociated with higher rates of morbidity and mortality. Perineal rectosigmo idectomy (Altemeier repair) is a safe and effective approach to the treatme nt of rectal prolapse and can be done as an outpatient procedure. In this a rticle, the results of a series of 63 consecutive Altemeier repairs are pre sented. METHODS: Between February 1993 and December 1999, 63 patients (61 f emales) underwent Altemeier repair of rectal prolapse. The mean patient age was 79 years. Preoperative, intraoperative, and postoperative data were co llected and analyzed for all patients. RESULTS: Median follow-up was 20.8 m onths. Seventy percent of patients were given a regional or local anestheti c. The average resected specimen length was 11.6 cm, and 83 percent of anas tomoses were stapled. Sixty-two percent of patients were discharged home on the day of surgery, and 80 percent were home within 24 hours. Complication s occurred in 10 percent of patients, but there was no perioperative mortal ity. There was a 6.4 percent recurrence rate, and all recurrences were succ essfully treated with repeat Altemeier repair. AU 63 patients had complete objective resolution of prolapse, and 87 percent had subjective improvement after repair. CONCLUSIONS: Altemeier repair of rectal prolapse is safe, pr oduces minimal discomfort, and does not require a general anesthetic. It is ideally suited to be done on an outpatient basis, as was done in the major ity of patients in our series. The recurrence rate is slightly higher than with abdominal resections, but morbidity and cost are lower, and repeat per ineal resections are easily and safely performed.