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Is it possible to reduce recurrences after Altemeier’s procedure for complete rectal prolapse? Twenty-year experience in 130 consecutive patients

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Abstract

Purpose

In the attempt to understand the reasons for and to find a solution to the high recurrence rate after perineal surgery for complete rectal prolapse, we retrospectively analysed the long-term results of Altemeier’s procedure alone, or associated with Trans-Obturator Colonic Suspension (TOCS) in a large series of patients with a median interval of 84 months (range 6–258).

Methods

Medical records of 110 patients undergoing Altemeier with levatorplasty (group 1) and 20 patients submitted to the same procedure associated with TOCS (group 2) for newly diagnosed complete rectal prolapse were reviewed. All patients had been recruited after preoperative clinical examination, SF-36 quality of life, continence score and colonoscopy.

Results

Mortality was nil. The overall complication and the recurrence rates were 12.3%, and 15.0% (P= 0.769) and 24.6% and 5.0% (P=0.067) in group 1 and 2, respectively. Twelve patients of group 1 with a recurrence were submitted to a redo-Altemeier, 8 to a redo-Altemeier associated with TOCS, and 6 associated with an anterior coloplasty with a mesh. The only patient of group 2 with a recurrence was submitted to a Hartmann’s operation. Preoperative vs postoperative mean (SD) continence score was 15.8 (3.1) and 15.6 (3.3) versus 4.1 (1.8) and 3.9 (1.9) in group 1 and 2, respectively (P < 0.001). All parameters of SF-36 improved after surgery (P<0.01) and no differences between the 2 groups were found

Conclusions

Long-term results confirmed the safety and effectiveness of Altemeier’s procedure for the treatment of complete rectal prolapse, with the limit of a non-negligible incidence of anastomotic complications and recurrences. The combination of Altemeier with TOCS showed a positive trend to a reduction of the recurrence rate, not worsening morbidity and outcomes.

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References

  1. Wijffels NA, Collinson R, Cunningham C, Lindsey I (2010) What is the natural history of internal rectal prolapse? Colorectal Dis 12(8):822–830

    Article  CAS  Google Scholar 

  2. Kairaluoma MV, Kellokumpu IH (2005) Epidemiologic aspects of complete rectal prolapse. Scand J Surg 94(3):207–210

    Article  CAS  Google Scholar 

  3. Altemeier WA, Culbertson WR, Schowengerdt C, Hunt J (1971) Nineteen years’ experience with one-stage perineal repair for rectal prolapse. Ann Surg 173:993–1006

    Article  CAS  Google Scholar 

  4. D'Hoore A, Penninckx F (2006) Laparoscopic ventral recto(colpo)pexy for rectal prolapse: surgical technique and outcome for 109 patients. Surg Endosc 20:1919–1923

    Article  CAS  Google Scholar 

  5. Ding JH, Canedo J, Lee SH, Kalaskar SN, Rosen L, Wexner S (2012) Perineal rectosigmoidectomy for primary and recurrent rectal prolapse: are the results comparable the second time? Dis Colon Rectum 55:666–670

    Article  Google Scholar 

  6. Zbar AP, Takashima S, Hasegawa T, Kitabayashi K (2002) Perineal rectosigmoidectomy (Altemeier’s procedure): a review of physiology, technique and outcome. Tech Coloproctol 2:106–116

    Google Scholar 

  7. Boccasanta P, Venturi M, Spennacchio M, Fratus G, Despini L, Roviaro G (2011) Trans-obturator colonic suspension during Altemeier’s operation for full-thickness rectal prolapse: preliminary results with a new technique. Colorectal Disease 14:616–632

    Article  Google Scholar 

  8. Agachan F, Reissman P, Pfeifer J, Weiss E, Nogueras J, Wexner SD (1997) Comparison of three perineal procedures for the treatment of rectal prolapse. South Med J 90:925–932

    Article  CAS  Google Scholar 

  9. Ware J Jr, Kosinki M, Keller SD (1996) A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 34:220–233

    Article  Google Scholar 

  10. Altomare DF, Spazzafumo L, Rinaldi M, Dodi G, Ghiselli R, Piloni V (2008) Set-up and statistical validation of a new scoring system for obstructed defecation syndrome. Colorectal Dis 10(1):84–88

    CAS  PubMed  Google Scholar 

  11. Boccasanta P, Venturi M, Barbieri S, Roviaro G (2006) Impact of new technologies on the clinical and functional outcome of Altemeier’s procedure: a randomized controlled trial. Dis Colon Rectum 49:652–660

    Article  Google Scholar 

  12. DeLeval J (2003) Novel surgical technique for the treatment of female stress urinary incontinence: trans-obturator vaginal tape inside-out. Eur Urol 44:724–730

    Article  Google Scholar 

  13. Vogt AW, Henson LC (1997) Unindicated preoperative testing: ASA physical status and financial implications. J Clin Anest 9:437–441

    Article  CAS  Google Scholar 

  14. Gonzales-Argente’ FX, Jain JJ, Nogueras JJ, Davila GW, Weiss EG, Wexner SD (2001) Prevalence and severity of urinary incontinence and pelvic genital prolapse in females with anal incontinence of rectal prolapse. Dis Colon Rectum 44:920–926

    Article  Google Scholar 

  15. Senapati A, Gray RG, Middleton LJ, Harding J, Hills RK, Armitage NC, Buckley L, Northover JM, PROSPER Collaborative Group (2013) PROSPER: a randomised comparison of surgical treatments for rectal prolapse. Colorectal Dis 15(7):858–868

    Article  CAS  Google Scholar 

  16. Emile SH, Elfeki H, Shalaby M, Sakr A, Sileri P, Wexner SD (2019) Outcome of laparoscopic ventral mesh rectopexy for full-thickness external rectal prolapse : a systematic review, meta analysis, and meta-regression analysis of the predictors of recurrence Surg. Endoscopy 33:2444–2455

    Article  Google Scholar 

  17. Fu CW, Stevenson AR (2017) Risk factors for recurrence after laparoscopic ventral rectopexy. Dis Colon Rectum 60(2):178–186

    Article  Google Scholar 

  18. Scherer R, Marti L, Hetzer FH (2008) Perineal stapled prolapse resection : a new procedure for external rectal prolapse. Dis Colon Rectum 51:1727–1730

    Article  Google Scholar 

  19. Fan K, Cao AM, Barto W, De Lacavalerie P (2020) Perineal stapled prolapse resection for external rectal prolapse : a systematic review and meta-analysis. Colorectal Dis doi 22:1850–1861. https://doi.org/10.1111/codi.15338

    Article  CAS  Google Scholar 

  20. Emile SH, Elfeki H, Shalaby M, Sakr A, Sileri P, Wexner SD (2017) Perineal resectional procedures for the treatment of complete rectal prolapse: a systematic review of the Literature. Int J Surg 46:146–154

    Article  Google Scholar 

  21. Elagili FL, Gurland B, Liu X, Church J, Ozuner G (2015) Comparing perineal repairs for rectal prolapse: Delorme versus Altemeier. Tech Coloproctol 19:521–525

    Article  CAS  Google Scholar 

  22. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  Google Scholar 

  23. Cirocco WC (2010) The Altemeier procedure for rectal prolapse: an operation for all ages. Dis Colon Rectum 58:1618–1623

    Article  Google Scholar 

  24. Pinhero LV, Leal RF, Coy CS, Fagundes JJ, Martinez CA, Ayrizono Mde L (2016) Long-term outcome of perineal rectosigmoidectomy for rectal prolapse. Int J Surg 32:78–82

    Article  Google Scholar 

  25. Kim M, Reibetanz J, Schlegel N, Germer C-T, Jayne D, Isbert C (2013) Perineal rectosigmoidectomy : quality of life. Colorectal Dis 15:1000–1006

    Article  CAS  Google Scholar 

  26. Gleditsch D, Wexels WA, Nesbakken A (2018) Surgical options and trends in treating rectal prolapse: long-term results in a 19-year follow-up study. Langenbeck’s Arch Surg 403:991–998

    Article  Google Scholar 

  27. Foppa C, Martinek L, Arnaud JP, Bergamaschi R (2014) Ten-year follow up after laparoscopic suture rectopexy for full-thickness rectal prolapse. Color Dis 16(10):809–814

    Article  CAS  Google Scholar 

  28. Williams NS, Giordano P, Dvorkin LS, Huang A, Hetzer FH, Scott SM (2005) External pelvic rectal suspension (the Express procedure) for full-thickness rectal prolapse: evolution of a new technique. Dis Colon Rectum 48:307–316

    Article  CAS  Google Scholar 

  29. Kim M, Reibetanz J, Schlegel N, Krajinovic K, Köstler H, Germer C-T, Isbert C (2014) Recurrence after perineal rectosigmoidectomy: when and why? Colorectal Dis 16:920–924

    Article  CAS  Google Scholar 

  30. Altomare DF, Binda G, Ganio E, De Nardi P, Giamundo P, Pescatori M (2009) Rectal prolapse study group. Long-term outcome of Altemeier’s procedure for rectal prolapse. Dis Colon Rectum 52(4):698–703

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Coloproctology & Pelvic Surgical Unit, Humanitas Gavazzeni Castelli, via G Mazzini 11, Bergamo, 24128, Italy

    Paolo Boccasanta, Sergio Agradi, Giuseppe Calabrò, Luca Bordoni, Claudio Missaglia & Umberto Favetta

  2. Day Week Surgery Departmental Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, via F Sforza 35, Milan, 20122, Italy

    Marco Venturi & Contardo Vergani

  3. Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via F. Sforza 35, 20122, Milan, Italy

    Marco Venturi & Contardo Vergani

Authors
  1. Paolo Boccasanta
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  2. Marco Venturi
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  3. Sergio Agradi
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  4. Giuseppe Calabrò
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  5. Luca Bordoni
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  6. Claudio Missaglia
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  7. Umberto Favetta
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  8. Contardo Vergani
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Paolo Boccasanta, Marco Venturi and Sergio Agradi. The first draft of the manuscript was written by Paolo Boccasanta, Marco Venturi and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Marco Venturi.

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Ethics approval and consent to participate

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of Humanitas Clinics Gavazzeni &Castelli approved this study. Informed consent was obtained from all individual participants included in the study.

Competing interests

The authors declare no competing interests.

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Boccasanta, P., Venturi, M., Agradi, S. et al. Is it possible to reduce recurrences after Altemeier’s procedure for complete rectal prolapse? Twenty-year experience in 130 consecutive patients. Langenbecks Arch Surg 406, 1591–1598 (2021). https://doi.org/10.1007/s00423-021-02091-2

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  • DOI: https://doi.org/10.1007/s00423-021-02091-2

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