altemeier procedure complicationsaltemeier procedure complications

The .gov means its official. Rectal prolapse: a 10-year experience. 2015;19(9):5215. Bethesda, MD 20894, Web Policies Only two patients who presented with rectal prolapse recurrence underwent a reoperation, one redo-Altemeiers procedure and one Goldbergs procedure. Altemeier procedure for rectal prolapse: multicentre study of anastomotic complications Br J Surg. The overall median decrease in ODS score was 1.5. The present study evaluated the morbidity, mortality, function and recurrence rate in patients undergoing Altemeiers operation for complete rectal prolapse. The relationship between recurrence and age, BMI, previous rectal prolapse surgery, previous hysterectomy, levatorplasty, length of resected bowel and gender was evaluated using an independent-sample t-test, Pearsons chi-squared test or Fishers exact test. On a positive note, mesh has been shown to be useful even in cleancontaminated surgery, so perhaps some of the negativity is unfounded6. Perineal excision of rectal procidentia in elderly high-risk patients. Patient satisfaction was determined using a simple numerical scale from 0 (not satisfied) to 10 (completely satisfied). Mayo Clinic. Which approach your surgeon uses depends on a number of factors, such as the size of your prolapse, your age, other health problems, your surgeon's experience and preferences, and equipment available. The relatively high number of recurrences after perineal repair should be balanced with the minimal invasiveness of the technique and the possibility of repeat it with no additional morbidity and considering the relatively long recurrence time. Rev Saude Publica. Altemeier's procedure for complete rectal prolapse; outcome and The present study evaluated the morbidity, mortality, function and recurrence rate in patients undergoing Altemeiers operation for complete rectal prolapse. Nineteen years experience with the one-stage perineal repair of rectal prolapse. Does this make perineal procedures obsolete? Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Surgery for complete (full-thickness) rectal prolapse in adults. Mario Trompetto, Email: ti.orebil@oiram.ottepmort. The ASA score was I [6 patients], II [21], III [15] and IV [1]. ODS score decreased with respect to levatorplasty and the change was statistically significant instead of Vaizey score in which were not. Statistical analysis: Descriptive data are presented as parametric data and non-parametric data. This may be further supported by the finding in the present study of an improvement in the ODS which will give some symptomatic relief. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. The median duration of the surgical procedure was 69 (50125) minutes. Epidemiologic aspects of complete rectal prolapse. Dis Colon Rectum. Failures with the Delorme operation have most often been associated with accompanying . The relationship between changes in the ODS score and Vaizey score in respect to levatorplasty was evaluated using the unpaired t-test and the Mann-Whitney U-test. There was no statistically significant difference in the Vaizey score before and after surgery (p=1.000) (Fig. Forty-three female patients (mean age 76.410years) underwent Altemeiers procedure between 2004 and 2015. Written informed consent was obtained from the patients. 8600 Rockville Pike There was no statistically significant difference in the Vaizey score before and after surgery (p=1.000) (Fig. Another method for repairing a rectal prolapse through the perineum (Delorme procedure) is more typically done for short prolapses. Rectal procidentia in elderly and debilitated patients. Post-operative complications at 30days occurred in 18 patients (38%). Delorme's Procedure for Complete Rectal Prolapse: Does It Still Have It Moreover, a recent Cochrane review failed to confirm the superiority of transabdominal over perineal procedures, due to the heterogeneity and poor quality of the available studies [31]. The relationship between post-operative complications and age, ASA and BMI was analyzed using the unpaired t-test. Rectal prolapse surgery is done to repair protrusion of the rectal lining through the anus. The high rate of recurrence at four years from surgery is likely to be multifactorial. Moreover, a recent Cochrane review failed to confirm the superiority of transabdominal over perineal procedures, due to the heterogeneity and poor quality of the available studies [31]. Experience with the one-stage perineal repair of rectal prolapse. Its the procedure not the patient: the operative approach is independently associated with an increased risk of complications after rectal prolapse repair. Until then, an Altemeier procedure is an excellent option for large prolapse in appropriately selected patients. Altemeiers procedure can be carried out under spinal anesthesia, avoiding the trauma of a laparotomy and permitting rapid recovery of alimentary function and mobility. General Surgery Issue Section: Research Letters Dear Editor Practice guidelines recommend perineal rectosigmoidectomy (Altemeier procedure) for rectal prolapse greater than 5 cm 1. Kimmins MH, Evetts BK, Isler J, et al. doi: 10.1093/bjs/znab409. Elagili F, Gurland B, Liu X, et al. So, it could be an available option for frail patients with complete rectal prolapse. 2004;240(2):20513. Marcello PW, Roberts PL. Mayo Clinic does not endorse companies or products. Perineal rectosigmoidectomy for rectal prolapse: role of levatorplasty. In the present study we evaluated the results of Altemeiers procedure in a sequential series of patients with complete rectal prolapse to determine the rates of early morbidity and mortality, the long term functions and recurrences. Continence was assessed pre and post-operatively using the Vaizey scoring system [6], which ranges from 0 (normal continence) to 24 (severe incontinence). who reported a statistically significant association of revision Altemeier procedure with recurrence or to the report of Kim et al. Bordeianou L, Paquette I, Johnson E, Holubar SD, Gaertner W, Feingold DL et al. All complications within 30 days after surgery are shown in Table 3. FOIA Part of The datasets generated and analysed during the current study are available from the corresponding author; a copy of the data was add as additional supporting file. The median hospital stay was longer in Altemeier's group [4 (1-44) days vs. 3 (0-14) days; p = 0.01]. Thirty four patients were assessed at a median interval of 49 (2135) months, six being deceased for reason not related to the prolapse and three lost to follow-up. The mean length of hospital stay was 6 [38] days. 10.1002/14651858.CD001758.pub3. 2011;13:5616. Altemeier's procedure is one of the well-known perineal operations to treat full-thickness rectal prolapse; it removes the prolapse without a pexy and. Advances in preoperative risk assessment and management. The rectum makes up the last several inches of the colon. The datasets generated and analysed during the current study are available from the corresponding author; a copy of the data was add as additional supporting file. April 8, 2021. Privacy Curr Probl Surg. The https:// ensures that you are connecting to the The Authors thank Miss Simona Graziani, head nurse of the Department of Colorectal Surgery at the Clinica Santa Rita, Vercelli, for her essential role in the preparation of this manuscript. This repair is typically reserved for those who are not candidates for open or laparoscopic repair. Vaizey CJ, Carapeti E, Cahill JA, et al. The relationship between recurrence and age, BMI, previous rectal prolapse surgery, previous hysterectomy, levatorplasty, length of resected bowel and gender was evaluated using an independent-sample t-test, Pearsons chi-squared test or Fishers exact test. The authors declare no conflicts of interest. 2010;53(12):161823. Color Dis. There were no statistically significant differences between patients with and without recurrence regarding age (p=0.188), BMI (p=0.864), ASA score (p=0.433), previously repaired prolapse (p=0.398), previous hysterectomy (p=0.705), length of resected bowel (p=0.126), and levatorplasty (p=0.304). Kim M, Reibetanz J, Boenicke L, Germer CT, Jayne D, Isbert C. Pizza F, DAntonio D, Ronchi A, Lucido FS, Brusciano L, Marvaso A et al. official website and that any information you provide is encrypted All patients were classified using the ODS score described by Altomare et al. We aimed to clarify whether laparoscopic suture rectopexy (lap-rectopexy) is suitable for Japanese patients with recurrent RP. Introduction Complete full-thickness rectal prolapse is a term that describes the protrusion of the full-thickness of the rectal wall through the anus [1]. Altemeier procedure for rectal prolapse: multicentre study of anastomotic complications. Google Scholar. Validation of the international consultation on incontinence questionnaire-short form(ICIQ-SF) for portuguese. The Altemeier repair: outpatient treatment of rectal prolapse. This technique involves a . Clinical practice guidelines for the treatment of rectal prolapse. The Authors thank Miss Simona Graziani, head nurse of the Department of Colorectal Surgery at the Clinica Santa Rita, Vercelli, for her essential role in the preparation of this manuscript. and transmitted securely. In contrast our data were similar to those of Ris et al. An official website of the United States government. The mean pre and post-operative scores for the various functional indices are shown in Table 1. Prolapse of the rectum, long-term results of surgical treatment. Surgical site and urinary tract infection were considered to be minor. Set-up and statistical validation of a new scoring system for obstructed defaecation syndrome. It offered improved evacuation in constipated patients while didn't improve fecal and urinary continence. Tamanini JTN, Dambros M, DAncona CAL, et al. The mean preoperative scores for constipation and incontinence, the ICIQ SF score and preoperative residual urinary volume score are given in Table1. This content does not have an Arabic version. Dis Colon Rectum. The Altemeier procedure for rectal prolapse: an operation for all ages. It offered improved evacuation in constipated patients while didn't improve fecal and urinary continence. ARL, RT, GG and EN gave substantial contribution to the acquisition, analysis and interpretation of data. Altemeier Procedure (Perineal Rectosigmoidectomy) Recurrence of the prolapse was analyzed. 2021 Dec 17;109(1):e10-e11. Most patients had no signs of peritonitis or systemic infection and only one underwent reoperation. It offered improved evacuation in constipated patients while didnt improve fecal and urinary continence. Tamanini JTN, Dambros M, DAncona CAL, et al. The average BMI was 22,2 ( 4.4). Tech Coloproctol. Dis Colon Rectum. BMC Surgery Color Dis. The Altemeier operation is therefore indicated for rectal prolapse. PubMedGoogle Scholar. Data on perioperative management including bowel preparation, antibiotic and thromboembolic prophylaxis, and type of anesthesia were also collected. This procedure is . This study was reviewed and approved by the Medical Ethical Committee of Zhongnan Hospital of Wuhan University. One patient showed an improvement in urinary retention but in all other patients the score was unchanged (p=1.000). Other complications after surgery include pelvic abscess, urogenital dysfunction, and anastomotic stenosis 2,3. Your surgeon will suggest the appropriate one for you based on your condition and your overall health. There was statistically significant differences in the ODS score changes between the 21 patients who underwent a levatorplasty and the 13 who did not with a median of differences of 0 in the group without plasty and of 2 in the group with plasty (p=0.0156) while there were no differences in Vaizey score changes (p=0.4524). MT, RT, GG, ARL and GC revised critically the work for important intellectual content. government site. There was statistically significant differences in the ODS score changes between the 21 patients who underwent a levatorplasty and the 13 who did not with a median of differences of 0 in the group without plasty and of 2 in the group with plasty (p=0.0156) while there were no differences in Vaizey score changes (p=0.4524). Emile SH, Elfeki H, Shalaby M, Sakr A, Sileri P, Wexner SD. Dis Colon Rectum. 1999;44(1):7780. Dindo D, Demartines N, Clavien PA. The relatively high number of recurrences after perineal repair should be balanced with the minimal invasiveness of the technique and the possibility of repeat it with no additional morbidity and considering the relatively long recurrence time. Murad-Regadas SM, Pinto RA. The pelvic cavity is relatively isolated from the peritoneum by an appropriately performed Altemeier procedure, which includes levatorplasty. Dindo D, Demartines N, Clavien PA. Surg Radiol Anat. Recurrences in our series occurred in 35% of cases, with an estimated risk of at 48months of 40% (Table4) [10,11,12,13,14,15,16,17,18, 24,25,26,27,28,29,30]. Rectal prolapse surgery is a procedure to repair rectal prolapse, which occurs when the last part of the large intestine (the rectum) stretches and protrudes from the anus. However, this procedure may require multiple firings of the staples, resulting in increased surgical costs. Your doctor is likely to recommend drinking lots of fluids, using stool softeners, and eating a fiber-rich diet in the weeks after surgery to avoid constipation and excessive straining that can lead to recurrence of the rectal prolapse. Few publications reported data on the effect of Altemeiers operation on function and those show different results among the series; data are summarized in Table 3 [10,11,12,13,14,15,16,17,18]. Rectal prolapse surgery is performed in people troubled by the pain and discomfort caused by rectal prolapse as well as the chronic symptoms that can accompany it, such as leakage of stool, inability to control bowel movements (fecal incontinence) or obstructed bowel movements. Patient satisfaction was determined using a simple numerical scale from 0 (not satisfied) to 10 (completely satisfied). Color Dis. A p-value of <0.05 was considered to be statistically significant. Altemeier procedure for rectal prolapse: multicentre study of anastomotic complications License CC BY-NC 4.0 Authors: Weicheng Liu Wuhan University Jianhua Ding Yiming Fang Wuhan University. There was no post-operative mortality at 30days. CAS The high rate of recurrence at four years from surgery is likely to be multifactorial. Informed consent was obtained from all patients. They found that a perineal approach was independently associated with a lower 30-day major and minor complication rate than any abdominal procedure. Published by Oxford University Press on behalf of BJS Society Ltd. A careful preoperative risk assessment of surgical and cardiopulmonary risks including ASA and functional status is mandatory to anticipate possible postoperative complications [20]. Xynos E. Functional results after surgery for overt rectal prolaps. General anesthesia was used in 18 (42%) patients and a spinal block in 25 (58%). In contrast to the many observational studies, the PROSPER randomized study, the largest on rectal prolapse, compared the recurrence rate, incontinence, bowel function and quality of life (QoL) of perineal and abdominal procedures and showed an improvement in symptom-specific and overall QoL for both types of procedure with a similar incidence of recurrence (28% vs 19%; p=0.2) and no significant difference in bowel function and QoL [15]. Surgical treatments proposed are divided in abdominal and perineal procedures. It was retrospective and the follow up was not performed in all patients. Springer Nature. Altemeier's procedure for complete rectal prolapse; outcome and Written informed consent was obtained from the patients. Google Scholar. Data on follow-up and recurrences. Friedman R, Muggia-Sulam M, Freund HR. Altemeiers procedure had in our series low complications rate and no mortality. 2015;(11). Surgery puts the rectum back in place. Methods Rectal prolapse: a 10-year experience. Day case robotic ventral rectopexy compared with day case laparoscopic ventral rectopexy: a prospective study. Color Dis. . 2015;(11). Long term, this procedure has been associated with higher recurrence rates than what has been reported with abdominal types of repair [5, 6]. [5]. Disclosure. In all, 13 patients (4.1 (95 per cent c.i. 2004;91:150024. Treatment of rectal prolapse. Correspondence to In the present study we evaluated the results of Altemeiers procedure in a sequential series of patients with complete rectal prolapse to determine the rates of early morbidity and mortality, the long term functions and recurrences. W.L., J.D. 30days morbidity according to Clavien-Dindo classification [4] and 30days mortality were recorded. 2013;15(7):85868. No.:CD001758. Ris F, Colin JF, Chilcott M, et al. The three axial perineal evaluation (TAPE) score: a new scoring system for comprehensive evaluation of pelvic floor function. The Mann-Whitney U-Test was used to evaluate patient satisfaction regarding recurrence. who found that the removal of a shorter specimen was followed by a higher risk of relapse [14, 17]. Kim M, Reibetanz J, Schlegel N, et al. 2012;59(2):214. 2005;27(5):4149. The Altemeier procedure for rectal prolapse: an operation for all ages. Many comparisons of the perineal and abdominal approaches have pointed to worsening or the de novo appearance of obstructed defecation in the case of the latter [19]. Risks vary, depending on surgical technique. . National Library of Medicine Grade 1 and 2 were a minimal anastomotic leakage successfully treated conservatively, four post-operative anemia requiring blood transfusion in two, eight fever, two transitory electrolyte disturbances and one urinary retention. Laparoscopic anterior rectopexy to the promontory for full-thickness rectal prolapse in 175 consecutive patients short- and long-term follow-up. Bader AM. (Related-Samples Sign Test for paired data), Comparison of the preoperative and postoperative Vaizey scores. Functional results and quality of life were shown to be very good in this journal a decade ago5. During this procedure, the surgeon pulls the rectum through the anus, removes a portion of the rectum and sigmoid colon and attaches the remaining rectum to the large intestine (colon). There was no post-operative mortality at 30days. Received 2018 Jan 21; Accepted 2018 Dec 18. (Additional file 1). Unfortunately, we have no data on their recurrence state. sharing sensitive information, make sure youre on a federal The cause of death was judged not to be treatment . Pre and post-operative functional scores and data above recurrences and time to recurrences collected from each patient. The ASA score was I [6 patients], II [21], III [15] and IV [1]. Interestingly, levatorplasty offered an improvement in the ODS score while hadnt any discernable effect on Vaizey score. Dis Colon Rectum. The three axial perineal evaluation (TAPE) score: a new scoring system for comprehensive evaluation of pelvic floor function. The site is secure. Surgical approach to rectal procidentia (rectal prolapse). It appears to be slightly more common in people who have the perineal procedure compared with an abdominal one. There are a number of ways to do rectal prolapse surgery. No.:CD001758. The surgical technique including the addition of levatorplasty to the rectosigmoidectomy, duration of the operation, the length of resected bowel, the interval from operation to the first bowel movement and the length of hospital stay were all recorded. Faucheron JL, Voirin D, Riboud R, et al. Perineal resectional procedures for the treatment of complete rectal Day case robotic ventral rectopexy compared with day case laparoscopic ventral rectopexy: a prospective study. PROSPER: a randomised comparison of surgical treatments for rectal prolapse. The authors declare that they have no competing interests. However, in some cases, constipation can worsen or become a problem when it wasn't one before surgery. The Mann-Whitney U-Test was used to evaluate patient satisfaction regarding recurrence. In contrast our data were similar to those of Ris et al. Altemeier's operation (perineal rectosigmoidectomy) is a surgical procedure used to correct full-thickness rectal prolapse. To explore the efficacy of modified Altemeier procedure in the Rectal prolapse has an estimated incidence of 2.5/100000 of the general population. 2004;38(3):43844. A p-value of <0.05 was considered to be statistically significant. Outcomes of rectal prolapse using the altemeier procedure. The online version of this article (10.1186/s12893-018-0463-7) contains supplementary material, which is available to authorized users. The modified Altemeier procedure for a loop colostomy prolapse - Springer 2017;60(11):112131. Treatment of rectal prolapse in the elderly by perineal rectosigmoidectomy. All parameters of SF-36 improved after surgery (P<0.01) and no differences between the 2 groups were found 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 aim of surgical repair is to remove the prolapse, with the additional hope of restoring continence and relieve any evacuation difficulty with minimal morbidity and mortality [2, 21]. (Wilcoxon signed rank test). Altomare D, Spazzafumo L, Rinaldi M, et al. Patient satisfaction showed a mean of 8.8 and 6.4 respectively in patients without and with recurrences (p=0.012). evaluated the perioperative outcome of patients with complete rectal prolapse from the American College of Surgeon National Surgical Quality Improvement Program (NSQIP) to determine the safety of different surgical approaches. Kim M, Reibetanz J, Schlegel N, et al. Each female had had a mean of 1.4 deliveries. Despite anatomical correction by surgery, patients frequently complain persisting pelvic floor symptoms and recurrences. Statistical analysis was conducted using SPSS software (SPSS, Chicago, Illinois, USA) and MedCalc Statistical Software (MedCalc Software, Ostend, Belgium). Anastomotic leakage is the most serious problem after the Altemeier procedure, with an incidence of 5.9%, and it can lead to life-threatening subsequent complications because patients with rectal prolapse are often elderly. ODS score decreased with respect to levatorplasty and the change was statistically significant instead of Vaizey score in which were not. There were no statistically significant differences between patients with and without recurrence regarding age (p=0.188), BMI (p=0.864), ASA score (p=0.433), recurrent prolapse (p=0.398), previous hysterectomy (p=0.705), length of resected bowel (p=0.126), and levatorplasty (p=0.304) (Table2). and Y.F. Fleming FJ, Kim MJ, Gunzler D, et al. What is rectal prolapse? 2012;14(3):3628. Cochrane Database Syst Rev. The overall median decrease in ODS score was 1.5. Marzouk D, Ramdass MJ, Haji A, et al. What is altemeier procedure? - Studybuff.com 2012;49(1):1140. Perineal rectosigmoidectomy (Altemeier's procedure) should be strongly considered in this situation. 3). In contrast the perineal approach which reduces rectal capacity and rectal wall compliance may increase the frequency of defecation, urgency and fecal incontinence in up to 40% of patients [21] with constipation reported in 10% [22]. As previously reported, six patients were deceased and three patients were lost to follow up leaving 34 with a median follow-up of 49 (2135) months. Surgical treatments for rectal prolapse: how does a perineal approach compare in the laparoscopic era? Weicheng Liu and others, Altemeier procedure for rectal prolapse: multicentre study of anastomotic complications, British Journal of Surgery, Volume 109, Issue 1, January 2022, Pages e10e11, https://doi.org/10.1093/bjs/znab409. The lining of the rectum is removed and the muscular layer folded to shorten the rectum. Bader AM. Altemeier Delorme Perineal stapled resection Outcomes 1. Murad-Regadas SM, Pinto RA. PubMed Central As previously reported, six patients were deceased and three patients were lost to follow up leaving 34 with a median follow-up of 49 (2135) months. Long term follow-up was performed in 34 available patients with three patients lost to follow up and six deceased for reasons related to their ages and comorbidity not related to the surgical procedure (they would have had at the time of long term follow-up an average age of 90years old with a median of 91years old) being excluded from the analysis. UpToDate All patients had a coloanal hand sewn anastomosis and in 25 (58%) a levatorplasty was also performed. Only two patients who presented with rectal prolapse recurrence underwent a reoperation, one redo-Altemeiers procedure and one Goldbergs procedure. Thereby it offers the advantages of minimal surgical stress and low post-operative morbidity and mortality. Of these 30, 14 had had a previous surgical repair for rectal prolapse by various techniques (4 Delorme, 2 STARR, 1 transanal proctopexy, 1 rectosigmoidectomy + anal encirclement, 1 rectopexy, 1 rectopexy with mesh, 1 Wells procedure, 3 no data), 24 had had a hysterectomy and seven had had a cystopexy. Int J Color Dis. The colon is a long tubelike organ in the abdomen. 2016;27(1):339. Abdominal repair require general anesthesia and may contribute to the possible formation of pelvic adhesions, posing a potential risk of infertility in young female and of impotence in males with the addition of the risk of anastomotic leakage if a resection rectopexy is performed even if resection is nowadays seldom performed [19]. 2016;20:695700. Laparoscopic ventral rectopexy for external rectal prolapse is safe and effective in the elderly. The score on patients satisfaction and the urinary retention score are not validated. The overall complication rate was lower in the 80 group (n = 5; 22.7%), however, not . But in general, rectal prolapse surgery risks include: To prepare for rectal prolapse surgery, your doctor may ask that you: You'll spend one or more days in the hospital after rectal prolapse surgery. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Method and Main outcome measures:The enrolled patients with complete rectal prolapse were divided into traditional and modified groups according to the . Friedman R, Muggia-Sulam M, Freund HR. The score on patients satisfaction and the urinary retention score are not validated. Postoperatively the first defecation occurred at 24/48h in 27 (63%) patients, at 72h in 10 (23%) and on the fourth-sixth post-op day in 6 (14%). Xynos E. Functional results after surgery for overt rectal prolaps. Resection rectopexy is a major surgery that comes with the following possible complications: Infection (external and internal) Injury to adjacent structures like ureter or vagina. 2006;30:65963. The procedure is well tolerated and is associated with few major complications. Abdominal repair require general anesthesia and may contribute to the possible formation of pelvic adhesions, posing a potential risk of infertility in young female and of impotence in males with the addition of the risk of anastomotic leakage if a resection rectopexy is performed even if resection is nowadays seldom performed [19]. Authors Weicheng Liu 1 . 2015;29(3):60713. 30days morbidity according to Clavien-Dindo classification [4] and 30days mortality were recorded. Dis Colon Rectum. One additional child experienced recurrence after an initial Thiersch procedure, and underwent a perineal resection of redundant rectum (modified Altemeier procedure). Altemeiers procedure is one of the well-known perineal operations to treat full-thickness rectal prolapse; it removes the prolapse without a pexy and performs only a partial reconstruction of the pouch of Douglas. Cirocco WC. Outcome of laparoscopic rectopexy versus perineal rectosigmoidectomy for full-thickness rectal prolapse in elderly patients.