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  • Symptomatic rectal prolapse with or without fecal incontinence.

Resection Rectopexy

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

Perineal Rectosigmoidectomy (Altemeier Procedure)

  • None.

Resection Rectopexy

Expected Benefits

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

Potential Risks

  • 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.

Perineal Rectosigmoidectomy (Altemeier Procedure)

Expected Benefits

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

Potential Risks

  • 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.

Resection Rectopexy

  • Standard general surgery set used in gastrointestinal surgery.

Perineal Rectosigmoidectomy (Altemeier Procedure)

  • Lone Star retractor.

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

Resection Rectopexy

  • 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.

Perineal Rectosigmoidectomy (Altemeier Procedure)

  • 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.

Resection Rectopexy

  • 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.

Figure 25–2

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