The surgical gold standard for the treatment of hemorrhoids is hemorrhoidectomy; for anal fissure, it is internal sphincterotomy; for ulcerative colitis, restorative proctocolectomy; for anal stricture, anoplasty, etc. However, for external rectal prolapse, there is no surgical gold standard, thus necessitating a tailored approach, i.e., a surgical procedure that addresses the patient’s needs and his or her symptoms. This conclusion was confirmed in two recent papers, by Pescatori and Zbar (2009) and Brown et al. (2004a). While in those studies the number of patients differed (117 and 157, respectively), the surgical policy was the same, with essentially the same operations carried out in each center: Altemeier proctosigmoidectomy and a Delorme procedure (via a perineal route), sacral rectopexy and resection-rectopexy (via an abdominal route). All four were tailored to the particular patient, the nature of the prolapse, and the symptoms. These cases also underline the need for a specialist to be able to perform more than one procedure and to adapt each of them to both the patient and the disease.


Rectal Prolapse Anal Continence Complete Rectal Prolapse Solitary Rectal Ulcer Syndrome Perineal Rectosigmoidectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Suggested Readings

  1. Agachan F, Pfeifer J, Joo JS, Nogueras JJ, Weiss EG, Wexner SD (1997) Results of perineal procedures for the treatment of rectal prolapse. Am Surg 63:9–12PubMedGoogle Scholar
  2. Agachan F, Reissman P, Pfeifer J, Weiss EG, Nogueras JJ, Wexner SD (1997) Comparison of three perineal procedures for the treatment of rectal prolapse. South Med J 90:925–932PubMedCrossRefGoogle Scholar
  3. Altemeier WA 3rd (1999) Pediatric orthopedic infections: missed diagnoses. Pediatr Ann 28:718–720PubMedGoogle Scholar
  4. Altomare DF, Binda G, Ganio E, De Nardi P, Giamundo P, Pescatori M; Rectal Prolapse Study Group (2009) Long-term outcome of Altemeier’s procedure for rectal prolapse. Dis Colon Rectum 52:698–703PubMedCrossRefGoogle Scholar
  5. Altomare DF, Pucciani P (2007) Perineal approach to external rectal prolapse: the Delorme procedure. In: Altomare DF, Pucciani F (2007) Rectal prolapse: Diagnosis and Clinical Management. Springer, pp 89–95Google Scholar
  6. Attuwaybi B, Visco J, Butler B, Cywinski M, Barrios G, Leberer J, Singh A (2010) The Buffalo experience with Altemeier procedure for rectal prolapse. Dis Colon Rectum 53:596–597Google Scholar
  7. Beck DE (2002) Surgical therapy for colitis cystica profunda and solitary rectal ulcer syndrome. Curr Treat Options Gastroenterol 5:231–237PubMedCrossRefGoogle Scholar
  8. Bellomo R, Morganti I (1982) Results of surgical treatment of mucosal prolapse of the rectum. Coloproctology 4:65–67Google Scholar
  9. Boccasanta P, Stuto A, Naldini G, Caviglia A, Carriero A (2006) Opinions and facts on reinterventions after complicated or failed stapled hemorrhoidectomy. Dis Colon Rectum 49:690–691; author reply 691–693PubMedCrossRefGoogle Scholar
  10. Brown AJ, Anderson JH, McKee RF, Finlay IG (2004) Strategy for selection of type of operation for rectal prolapse based on clinical criteria. Dis Colon Rectum 47:103–107PubMedCrossRefGoogle Scholar
  11. Brown AJ, Anderson JH, McKee RF, Finlay IG (2004) Surgery for occult rectal prolapse. Colorectal Dis 6:176–179PubMedCrossRefGoogle Scholar
  12. Carditello A, Milone A, Stilo F, Mollo F, Basile M (2003) Surgical treatment of rectal prolapse with transanal resection according to Altemeier. Experience and results. Chir Ital 55:687–692Google Scholar
  13. Carriero A, Martellucci J, Talento P (2010) Perineal stapled rectal resection with Contour tranSTARR with Lone Star retractor system. Dis Colon Rectum 53:597Google Scholar
  14. Carriero A, Picchio M, Martellucci J, Talento P, Palimento D, Spaziani E (2010) Laparoscopic correction of enterocele associated to stapled transanal rectal resection for obstructed defecation syndrome. Int J Colorectal Dis 25:381–387PubMedCrossRefGoogle Scholar
  15. Christiansen J (1987) The Delorme operation with retro-anal plication of the levator muscle in treatment of total prolapse of the rectum. Ann Chir 41:507–511PubMedGoogle Scholar
  16. Chun SW, Pikarsky AJ, You SY et al (2004) Perineal rectosigmoidectomy for rectal prolapse: role of levatorplasty. Tech Coloproctol 8:3–8PubMedCrossRefGoogle Scholar
  17. Cirocco WC (2010) The Altemeier procedure for rectal prolapse: an operation for all ages. Dis Colon Rectum 53:1618–1623PubMedCrossRefGoogle Scholar
  18. Corman ML, Carriero A, Hager T et al (2006) Consensus conference on the stapled transanal rectal resection (STARR) for disordered defaecation. Colorectal Dis 8:98–101PubMedCrossRefGoogle Scholar
  19. De Nardi P, Osman N, Viola M, Staudacher C (2006) Ischemic proctitis following Delorme procedure for external rectal prolapse. Tech Coloproctol 10:253–255PubMedCrossRefGoogle Scholar
  20. Dekel A, Rabinerson D, Rafael ZB, Kaplan B, Mislovaty B, Bayer Y (2000) Concurrent genital and rectal prolapse: two pathologies—one joint operation. BJOG 107:125–129PubMedCrossRefGoogle Scholar
  21. Dippolito A, Esser S, Reed J 3rd (2005) Anterior modification of Delorme procedure provides equivalent results to Delorme procedure in treatment of rectal outlet obstruction. Curr Surg 62:609–612PubMedCrossRefGoogle Scholar
  22. El-Sibai O, Shafik AA (2002) Cauterization-plication operation in the treatment of complete rectal prolapse. Tech Coloproctol 6:51–54PubMedCrossRefGoogle Scholar
  23. Flum AS, Golladay ES, Teitelbaum DH (2010) Recurrent rectal prolapse following primary surgical treatment. Pediatr Surg Int 26:427–431PubMedCrossRefGoogle Scholar
  24. Glasgow SC, Birnbaum EH, Kodner IJ, Fleshman JW, Dietz DW (2006) Preoperative anal manometry predicts continence after perineal proctectomy for rectal prolapse. Dis Colon Rectum 49:1052–1058PubMedCrossRefGoogle Scholar
  25. Gourgiotis S, Baratsis S (2007) Rectal prolapse. Int J Colorectal Dis 22:231–243PubMedCrossRefGoogle Scholar
  26. Gramkow CS, Lanng C, Fischer A (2005) Altemeier repair of rectal prolapse. Ugeskr Laeger 167:286–289PubMedGoogle Scholar
  27. Gravante G, Venditti D (2006) The Altemeier procedure: new technologies for an old technique. Dis Colon Rectum 49:1801–1802. Comment on: Dis Colon Rectum 49:652–660PubMedCrossRefGoogle Scholar
  28. Gurland B, Garrett KA, Firoozi F, Goldman HB (2010) Transvaginal sacrospinous rectopexy: initial clinical experience. Tech Coloproctol 14:169–173PubMedCrossRefGoogle Scholar
  29. Kim M, Reibetanz J, Boenicke L, Germer CT, Jayne D, Isbert C (2010) Quality of life after transperineal rectosigmoidectomy. Br J Surg 97:269–272PubMedCrossRefGoogle Scholar
  30. Kimmins MH, Evetts BK, Isler J, Billingham R (2001) The Altemeier repair: outpatient treatment of rectal prolapse. Dis Colon Rectum 44:565–570PubMedCrossRefGoogle Scholar
  31. Kling KM, Rongione AJ, Evans B, McFadden DW (1996) The Delorme procedure: a useful operation for complicated rectal prolapse in the elderly. Am Surg 62:857–860PubMedGoogle Scholar
  32. Kosba Y, Elshazly WG, Abd El Maksoud W (2010) Posterior sagittal approach for mesh rectopexy as a management of complete rectal in adults. Int J Colorectal Dis 25:881–886PubMedCrossRefGoogle Scholar
  33. Lauretta A, Bellomo R, Infantino A (2010) Which approach for complete rectal prolapse? Orr-Loygue rectopexy vs. Delorme procedure. Dis Colon Rectum 53:596Google Scholar
  34. Lazorthes F, Liagre A, Iovino F (2000) Rectal prolapse. J Chir 137:76–81Google Scholar
  35. Lechaux JP, Lechaux D, Perez M (1995) Results of Delorme’s procedure for rectal prolapse. Advantages of a modified technique. Dis Colon Rectum 38:301–307PubMedCrossRefGoogle Scholar
  36. Lee JI, Vogel AM, Suchar AM, Glynn L, Statter MB, Liu DC (2006) Sequential linear stapling technique for perineal resection of intractable pediatric rectal prolapse. Am Surg 72:1212–1215PubMedGoogle Scholar
  37. Lehtola A, Salo JA, Fräki O, Lempinen M (1987) Treatment of rectal prolapse. A clinical study of 50 consecutive patients. Ann Chir Gynaecol 76:150–154PubMedGoogle Scholar
  38. Liberman H, Hughes C, Dippolito A (2000) Evaluation and outcome of the Delorme procedure in the treatment of rectal outlet obstruction. Dis Colon Rectum 43:188–192PubMedCrossRefGoogle Scholar
  39. Lieberth M, Kondylis LA, Reilly JC, Kondylis PD (2009) The Delorme repair for full-thickness rectal prolapse: a retrospective review. Am J Surg 197:418–423PubMedCrossRefGoogle Scholar
  40. Lieske B, Conaghan P, Farouk R (2010) Outcome after stapled perineal rectosigmoidectomy using tranSTARR. Dis Colon Rectum 53:581Google Scholar
  41. Madiba TE, Baig MK, Wexner SD (2005) Surgical management of rectal prolapse. Arch Surg 140:63–73PubMedCrossRefGoogle Scholar
  42. Marchal F, Bresler L, Ayav A et al (2005) Long-term results of Delorme’s procedure and Orr-Loygue rectopexy to treat complete rectal prolapse. Dis Colon Rectum 48:1785–1790PubMedCrossRefGoogle Scholar
  43. Martínez Hernández-Magro P, Villanueva Sáenz E, Sandoval Munro RD (2003) Surgical treatment of complete rectal prolapse. Experience at a colon and rectal surgery service. Rev Gastroenterol 68:185–191Google Scholar
  44. Milito G, Cadeddu F, Selvaggio I, Grande M (2010) The Delorme repair for full-thickness rectal prolapse: a retrospective review. Am J Surg 199:581–582PubMedCrossRefGoogle Scholar
  45. Mongardini M, Iachetta RP, Cola A, Effetti ED, Custureri F (2009) Altemeier operation associated with dynamic graciloplasty: a case report. J Med Case Reports 3:9317CrossRefGoogle Scholar
  46. Müller-Lobeck H, Duschka L, Schleifer P, Henne T (1996) Rehn-Delorme operation in pelvic floor insufficiency. Zentralbl Chir 121:692–697PubMedGoogle Scholar
  47. Oliver GC, Vachon D, Eisenstat TE, Rubin RJ, Salvati EP (1994) Delorme’s procedure for complete rectal prolapse in severely debilitated patients. An analysis of 41 cases. Dis Colon Rectum 37:461–467PubMedCrossRefGoogle Scholar
  48. Pascual Montero JA, Martínez Puente MC, Pascual I et al (2006) Complete rectal prolapse clinical and functional outcome with Delorme’s procedure. Rev Esp Enferm Dig 98:837–843Google Scholar
  49. Pescatori M, Dodi G, Salafia C, Zbar AP (2005) Rectovaginal fistula after double-stapled transanal rectotomy (STARR) for obstructed defaecation. Int J Colorectal Dis 20:83–85PubMedCrossRefGoogle Scholar
  50. Pescatori M, Favetta U, Dedola S, Orsini S (1997) Stapled transanal excision of rectal mucosal prolapse. Tech Coloproctol 1:96–98Google Scholar
  51. Pescatori M, Zbar AP (2009) Tailored surgery for internal and external rectal prolapse: functional results of 268 patients operated upon by a single surgeon over a 21-year period. Colorectal Dis 11:410–419PubMedCrossRefGoogle Scholar
  52. Regenet N, De Kerviler B, Lehur PA (2001) Perineal rectosigmoid resection for exterior rectal prolapse (Altemeier operation). J Chir 138:153–156Google Scholar
  53. Romano G, Bianco F, Caggiano L (2009) Modified perineal stapled rectal resection with Contour Transtar for full-thickness rectal prolapse. Colorectal Dis 11:878–881PubMedCrossRefGoogle Scholar
  54. Sailer M, Bönicke L, Petersen S (2007) Surgical options in the treatment of rectal prolapse: indications, techniques and results. Zentralbl Chir 132:350–357PubMedCrossRefGoogle Scholar
  55. Scherer R, Marti L, Hetzer FH (2008) Perineal stapled prolapse resection: a new procedure for external rectal prolapse. Dis Colon Rectum 51:1727–1730PubMedCrossRefGoogle Scholar
  56. Sewonou A, Rioux C, Golliot F et al (2002) Incidence of surgical site infection in ambulatory surgery: results of the INCISCO surveillance network in 1999–2000. Ann Chir 127:262–267PubMedCrossRefGoogle Scholar
  57. Sielezneff I, Bulgare JC, Sastre B, Sarles JC (1995) Result of surgical treatment of exteriorized rectal prolapse in adults. Experience of 21 years. Ann Chir 49:396–4PubMedGoogle Scholar
  58. The Altemeier repair: outpatient treatment of rectal prolapse. Kimmins MH, Evetts BK, Isler J, Billingham R (2001) Dis Colon Rectum 44:565–570PubMedCrossRefGoogle Scholar
  59. Tobin SA, Scott IH (1994) Delorme operation for rectal prolapse. BrJSurg 81:1681–1684Google Scholar
  60. Voulimeneas I, Antonopoulos C, Alifierakis E, Ioannides P (2010) Perineal rectosigmoidectomy for gangrenous rectal prolapse. World J Gastroenterol 16:2689–2691PubMedCrossRefGoogle Scholar
  61. Watkins BP, Landercasper J, Belzer GE et al (2003) Long-term follow-up of the modified Delorme procedure for rectal prolapse. Arch Surg 138:498–502; discussion 502–503PubMedCrossRefGoogle Scholar
  62. Watts AM, Thompson MR (2000) Evaluation of Delorme’s procedure as a treatment for full-thickness rectal prolapse 87:218–222Google Scholar
  63. Zbar AP, Takashima S, Hasegawa T, Kitabayashi K (2002) Perineal rectosigmoidectomy (Altemeier’s procedure): a review of physiology, technique and outcome. Tech Coloproctol 6:109–116PubMedCrossRefGoogle Scholar
  64. Zuo ZG, Song HY, Xu C et al (2010) Application of Altemeier procedure in the emergent management of acute incarcerated rectal prolapse. Zhonghua Wei Chang Wai Ke Za Zhi 13:427–429PubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2012

Authors and Affiliations

  • Mario Pescatori
    • 1
  1. 1.Coloproctology UnitArs Medica Hospital and La Sapienza UniversityRomeItaly

Personalised recommendations