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Impact of New Technologies on the Clinical and Functional Outcome of Altemeier's Procedure: A Randomized, Controlled Trial

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Diseases of the Colon & Rectum

Purpose

A randomized study was performed to assess whether new technologies offer advantages over the conventional technique on the clinical and functional outcome of patients with full-thickness rectal prolapse and fecal incontinence, submitted to Altemeier's procedure with levatorplasty.

Methods

Between January 1999 and December 2003, 58 patients (55 females; mean age, 70.9 ± 11.3 years) with full-thickness rectal prolapse were evaluated with continence score, colonoscopy, anorectal manometry, anal electromyography, and sacral reflex latency; 40 of them were selected and randomly assigned to two groups: 20 patients (Group 1; 19 females, 73.4 ± 10.4 years) were submitted to a conventional operation with monopolar electrocautery and handsewn anastomosis, and 20 (Group 2; 18 females, 71.5 ± 12.2 years) using harmonic scalpel and circular stapler. Patients were followed up with clinical examination, anorectal manometry, and anal electromyography, with mean follow-up 29.3 ± 8.5 and 27.5 ± 9.2 months in Groups 1 and 2, respectively.

Results

Operative time, blood loss, and hospital stay were significantly reduced in Group 2 (P < 0.001), whereas no differences were found in pain score, time to return to normal activity, morbidity, and mortality. Complications were two (10 percent) stenosis in Group 1. Fecal continence score significantly improved in both groups (P < 0.01), whereas anorectal manometry and neurophysiologic data were not significantly modified by the operation. Recurrence rates were 15 and 10 percent in Groups 1 and 2, respectively (P= not significant).

Conclusions

The clinical and functional long-term results of perineal rectosigmoidectomy with levatorplasty are not influenced by surgical instruments and type of coloanal anastomosis. The clinical relevance of the short-term results in high-risk patients should be specifically investigated.

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Authors and Affiliations

  1. Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, IRCCS Foundation, 1st Department of General Surgery, University of Milan, Milan, Italy

    Paolo Boccasanta M.D., Marco Venturi M.D. & Giancarlo Roviaro M.D.

  2. Department of Neurologic Sciences, University of Milan, Milan, Italy

    Sergio Barbieri M.D.

  3. Via G.B. Morgagni 39, 20129, Milan, Italy

    Paolo Boccasanta M.D.

Authors
  1. Paolo Boccasanta M.D.
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  2. Marco Venturi M.D.
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  3. Sergio Barbieri M.D.
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  4. Giancarlo Roviaro M.D.
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Corresponding author

Correspondence to Paolo Boccasanta M.D..

Additional information

Supported by a grant from “Fondazione Camillo Corti per la Ricerca sulle Malattie del Colon,” Milano, Italy. No financial contribution has been received from any potentially interested party during preparation of this clinical study. The Governing Council of the Italian United Society of Coloproctology (SIUCP) approved the study protocol and did not receive any financial support for this investigation.

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Boccasanta, P., Venturi, M., Barbieri, S. et al. Impact of New Technologies on the Clinical and Functional Outcome of Altemeier's Procedure: A Randomized, Controlled Trial. Dis Colon Rectum 49, 652–660 (2006). https://doi.org/10.1007/s10350-006-0505-6

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  • DOI: https://doi.org/10.1007/s10350-006-0505-6

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