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  • Symptomatic rectal prolapse with or without fecal incontinence.

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Resection Rectopexy

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  • Elderly patients with limited life expectancy.
  • Patients with severe comorbidities or those unable to tolerate general anesthesia or major abdominal surgery.

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Perineal Rectosigmoidectomy (Altemeier Procedure)

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  • None.

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Resection Rectopexy

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Expected Benefits

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  • Resection rectopexy is more durable than perineal rectosigmoidectomy and can often be performed via a laparoscopic approach.

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Potential Risks

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  • Bleeding or hematoma development requiring reoperation.
  • Wound infection.
  • Injury to one or both ureters requiring repair.
  • Sexual dysfunction, including impotence or retrograde ejaculation in men.
  • Incisional hernia.
  • Possible temporary or permanent colostomy.

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Perineal Rectosigmoidectomy (Altemeier Procedure)

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Expected Benefits

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  • Preferred over an abdominal approach in high-risk patients.

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Potential Risks

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  • Infection, most notably perirectal abscess.
  • Bleeding, primarily from the sacral venous plexus but also potentially from the mesenteric vascular supply divided as part of the procedure.
  • Anastomotic dehiscence.
  • Recurrence of rectal prolapse.
  • Loss of or failure to regain fecal continence.

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Resection Rectopexy

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  • Standard general surgery set used in gastrointestinal surgery.

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Perineal Rectosigmoidectomy (Altemeier Procedure)

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  • Lone Star retractor.

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  • Complete colonoscopy (preferable) or barium enema and sigmoidoscopy to rule out malignancy or other colonic disease.
  • Bowel preparation according to surgeon preference.

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Resection Rectopexy

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  • The patient should be supine on the operating table.
  • A Foley catheter is placed to decompress the bladder.
  • Either a nasogastric or an orogastric tube is placed to decompress the stomach.

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Perineal Rectosigmoidectomy (Altemeier Procedure)

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  • The patient may be positioned either in the lithotomy position or in the prone jackknife position.
  • A Foley catheter is inserted to decompress the bladder.
  • A Lone Star retractor is used for exposure.

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Resection Rectopexy

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  • Figure 25–1: As the normal rectal attachments become lax, the rectum intussuscepts through the pelvic floor, telescoping through the anus.
  • Figure 25–2: The redundant sigmoid colon is resected in the usual manner, down to the peritoneal reflection.
    • The peritoneum is incised posteriorly and laterally to mobilize the rectosigmoid out of the pelvis, but the lateral attachments of the rectum are left intact.
    • Redundant rectosigmoid is resected.
    • The proximal colon is then anastomosed to the rectum to provide intestinal continuity and the rectum is sutured to the presacral fascia to fix it in place.
  • Figure 25–3: The completed procedure is shown, with the anastomotic line at or below the peritoneal reflection and tacking sutures between the rectum and the presacral fascia fixing the colon in place.

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Figure 25–2
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