The three axial perineal evaluation (TAPE) score: a new scoring system for comprehensive evaluation of pelvic floor function. Altemeiers procedure can be carried out under spinal anesthesia, avoiding the trauma of a laparotomy and permitting rapid recovery of alimentary function and mobility. The relationship between post-operative complications and age, ASA and BMI was analyzed using the unpaired t-test. Kim M, Reibetanz J, Schlegel N, et al. 2013;15(7):620. No procedure is considered the best overall. 2005;140(1):6373. 2014;16(6):45968. Tamanini JTN, Dambros M, DAncona CAL, et al. 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. Despite anatomical correction by surgery, patients frequently complain persisting pelvic floor symptoms and recurrences. The Altemeier procedure is a surgical option for rectal prolapse, particularly in high-risk surgical candidates. of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy, Department of Biostatistics, S.Gaudenzio Clinic, Policlinico di Monza, Italy, Department of General Surgery, University of Catanzaro, Catanzaro, Italy, You can also search for this author in W.L., J.D. Tech Coloproctol. PDF Information on Altemeier's operation - Wirral Surgeon 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. Senapati A, Gray RG, Middleton LJ, et al. Clinical practice guidelines for the treatment of rectal prolapse. The probability of recurrence at 48months was determined using the Kaplan-Meier method. Kairaluoma MV, Kellokumpu IH. Altomare DF, Di Lena M, Giuratrabocchetta S, et al. 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. There was no statistically significant difference in the Vaizey score before and after surgery (p=1.000) (Fig. This content does not have an English version. Altemeier WA, Culbertson WR, Schowengerdt C, et al. Advertising revenue supports our not-for-profit mission. 2013;15(7):85868. The median hospital stay was longer in Altemeier's group [4 (1-44) days vs. 3 (0-14) days; p = 0.01]. The etiology is multifactorial and includes weakness of the pelvic floor, chronic constipation, multiple pregnancies, previous pelvic surgery and a deep pouch of Douglas [2]. It offered improved evacuation in constipated patients while didn't improve fecal and urinary continence. Authors Weicheng Liu 1 . 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. Treatment of rectal prolapse. Machine learning risk prediction of mortality for patients undergoing surgery with perioperative SARS-CoV-2: the COVIDSurg mortality score, Diversity, Equity, Inclusion, and Accessibility, https://creativecommons.org/licenses/by-nc/4.0/, Receive exclusive offers and updates from Oxford Academic. Google Scholar. Despite the finding of a higher satisfaction in all patients it is not surprising that this was largely due to the benefit perceived by the patients not developing recurrences. American College of Surgeon National Surgical Quality Improvement Program, American society of anesthesiologists score, International Classification of Diseases- 9, International Consultation on Incontinence Questionnaire Short Form score. The aim of this retrospective study was to evaluate morbidity, mortality, postoperative function and recurrences in patients treated by Altemeiers rectosigmoidectomy for complete rectal prolapse in a referral center for pelvic floor functional disorders. 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. Abdominal approaches have been shown to be associated with lower rates of recurrence than perineal procedures after which rates of up to 58% have been reported [19, 23]. The median length of the resected bowel was 20 (1270) centimeters. Arch Surg. Comparison between pre-operative and post-operative functional scores was performed using the paired t-test or Wilcoxons rank sum test for paired data. Authors declare they have no supportive foundations. This retrospective study was approved by the ethics committee of the Azienda Ospedaliera Nazionale ss. Surgical site and urinary tract infection were considered to be minor. The average time to recurrence was 17months (SD 9.8- range 536). Results:The overall complication rates were 33.33% and 6.67% and recurrence rates were 26.67% and 7% in the traditional and modified groups, respectively (P<0.05)The duration of surgery in the. 2012;14(9):110611. All patients received a complete bowel preparation, antibiotic prophylaxis (Cefazolin and Metronidazole) and thromboembolic prophylaxis (low-molecular-weight heparin). Its the procedure not the patient: the operative approach is independently associated with an increased risk of complications after rectal prolapse repair. who reported a statistically significant association of revision Altemeier procedure with recurrence or to the report of Kim et al. Surgery puts the rectum back in place. Data on follow-up and recurrences. There was no post-operative mortality at 30days. Art. 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). (Additionalfile1). The median length of the resected bowel was 20 (1270) centimeters. 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). At the same follow-up there were 12 (35%) cases of recurrence with an estimated risk at 48months of 40%. Careers, Unable to load your collection due to an error. Comparing perineal repairs for rectal prolapse: Delorme versus Altemeier. In this multicentre retrospective study, 318 patients from 10 hospitals (from 2010 to 2021) were analysed. Does this make perineal procedures obsolete? Nineteen years experience with the one-stage perineal repair of rectal prolapse. 1). 2012;14(3):3628. Altemeiers procedure for complete rectal prolapse; outcome and function in 43 consecutive female patients. In our series although a statistically significant reduction in the ODS score was found, there was no change in any of the other parameters used to assess bowel and urinary function. Outcome of laparoscopic rectopexy versus perineal rectosigmoidectomy for full-thickness rectal prolapse in elderly patients. MT, RT, GG, ARL and GC revised critically the work for important intellectual content. Rectal prolapse repair through the area around the anus (perineal rectosigmoidectomy). Resection-rectopexy had doubled the rate of complications than rectopexy alone [9]. Altemeier Delorme Perineal stapled resection Outcomes 1. Rev Saude Publica. Color Dis. Validation of the international consultation on incontinence questionnaire-short form(ICIQ-SF) for portuguese. Perineal rectosigmoidectomy for primary and recurrent rectal prolapse: are the results comparable the second time? Chua HK (expert opinion). Treatment of rectal prolapse in the elderly by perineal rectosigmoidectomy. 2017;60(11):112131. The pelvic cavity is relatively isolated from the peritoneum by an appropriately performed Altemeier procedure, which includes levatorplasty. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. The present study evaluated the morbidity, mortality, function and recurrence rate in patients undergoing Altemeiers operation for complete rectal prolapse. Color Dis. 1994;37(10):102730. 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. Tech Coloproctol. This may be further supported by the finding in the present study of an improvement in the ODS which will give some symptomatic relief. Rectal prolapse happens when the rectum becomes stretched and sticks out from the anus. Xynos E. Functional results after surgery for overt rectal prolaps. To note that in contrast to the reports of open abdominal corrections of the prolapse, laparoscopic ventral rectopexy is actually largely spread and it showed comparable morbidity and lower mortality rates, improved short term outcomes and shorter hospital stay than perineal surgery and moreover less morbidity in comparison to the open abdominal procedures [3236]. Recurrences in our series occurred in 35% of cases, with an estimated risk of at 48months of 40% (Table4) [1018, 2430]. Elagili F, Gurland B, Liu X, et al. The attempt to improve function is based on the assumption that the restoration of the anatomy will lead to relief of disturbances of function [22]. 2004;8(1):39. Recurrence after perineal rectosigmoidectomy: when and why? They found that a perineal approach was independently associated with a lower 30-day major and minor complication rate than any abdominal procedure. BMC Surgery Your US state privacy rights, of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy, 3Department of Biostatistics, S.Gaudenzio Clinic, Policlinico di Monza, Italy, 4Department of General Surgery, University of Catanzaro, Catanzaro, Italy. Furthermore functional outcomes (constipation, continence and outlet obstruction) after laparoscopic ventral rectopexy were at least equivalent as the ones after open abdominal or perineal procedures [36, 37]. https://doi.org/10.1002/14651858.CD001758.pub3. Female gender with possible obstetric trauma, the wider pelvis and weaker pelvic floor due to age and gender are factors that would contribute to poor function and the failure of repair of the prolapse to alter most of the functional scores indicates that the prolapse itself may not be an important factor in the bowel and urinary dysfunction often observed in patients with prolapse. 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]. They divided complications into minor and major, taking major complications to include organ space infection, cardiac and thromboembolic events, ventilator dependence, pneumonia, return to the operating room, renal failure and sepsis. Treatment of rectal prolapse. and transmitted securely. Ochsner J. Ris F, Colin JF, Chilcott M, et al. Informed consent was obtained from all patients. Comparison of four surgical approaches for rectal prolapse: multicentre Fecal incontinence improved in 11 patients, worsened in 10 and was unchanged in 13. This retrospective study was approved by the ethics committee of the Azienda Ospedaliera Nazionale ss. Rectal prolapse surgery is done to repair protrusion of the rectal lining through the anus. Faucheron JL, Voirin D, Riboud R, et al. 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. The attempt to improve function is based on the assumption that the restoration of the anatomy will lead to relief of disturbances of function [22]. You'll begin by drinking clear liquids and transition to solid foods. (XLSX 20 kb). 2007;7(1):2432. the contents by NLM or the National Institutes of Health. A p-value of <0.05 was considered to be statistically significant. These interesting results are actually changing the attitude toward a use of this minimal invasive abdominal technique in the management of full thickness rectal prolapse for all patients. Patient satisfaction showed a mean of 8.8 and 6.4 respectively in patients without and with recurrences (p=0.012). It offered improved evacuation in constipated patients while didnt improve fecal and urinary continence. Patient satisfaction showed a mean of 8.8 and 6.4 respectively in patients without and with recurrences (p=0.012). 2009;24(2):2017. Antonio e Biagio e Cesare Arrigo-Alessandria, Italy and is in accordance with the Declaration of Helsinki. Comparison between pre-operative and post-operative functional scores was performed using the paired t-test or Wilcoxons rank sum test for paired data. Dis Colon Rectum. 2015;(11). Epidemiologic aspects of complete rectal prolapse. Altemeiers procedure for complete rectal prolapse; outcome and function in 43 consecutive female patients, https://doi.org/10.1186/s12893-018-0463-7, https://doi.org/10.1002/14651858.CD001758.pub3, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. https://doi.org/10.1186/s12893-018-0463-7, DOI: https://doi.org/10.1186/s12893-018-0463-7. The Mann-Whitney U-Test was used to evaluate patient satisfaction regarding recurrence. 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]. Br J Surg. 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. Altomare D, Spazzafumo L, Rinaldi M, et al. Tou S, Brown SR, Nelson RL. It appears to be slightly more common in people who have the perineal procedure compared with an abdominal one. who found no association between the length of the resected bowel and recurrence [13]. In literature morbidity ranges from 3 to 35% and mortality is very unfrequently reported (Table3) [10,11,12,13,14,15,16,17,18]. April 8, 2021. Methods: Short-term outcomes and QOL were compared. (Additionalfile1). The colon carries waste to be expelled from the body. Rectal prolapse has an estimated incidence of 2.5/100000 of the general population. In our series although a statistically significant reduction in the ODS score was found, there was no change in any of the other parameters used to assess bowel and urinary function. Rectal prolapse surgery requires anesthesia. 2001;44(4):56570. Hoel AT, Skarstein A, Ovrebo KK. Thereby it offers the advantages of minimal surgical stress and low post-operative morbidity and mortality. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Mario Trompetto, Email: ti.orebil@oiram.ottepmort. Most people are able to return to normal activities within 4 to 6 weeks after surgery. The Mann-Whitney U-Test was used to evaluate patient satisfaction regarding recurrence. In our series, this complication was prevented by postoperative bladder training with a Foley catheter [2, 3, 5, 8]. Cookies policy. 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]. Bordeianou L, Paquette I, Johnson E, et al. The score on patients satisfaction and the urinary retention score are not validated. HHS Vulnerability Disclosure, Help Perineal rectosigmoidectomy for rectal prolapsethe preferred procedure 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. Nineteen years experience with the one-stage perineal repair of rectal prolapse. 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]. 2006;30:65963. The authors declare that they have no financial and personal relationships with other people or organizations that can inappropriately influence their work, there is no professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of, the manuscript entitled Altemeier procedure for rectal prolapse: multicentre study of anastomotic complications. (Related-Samples Sign Test for paired data), Comparison of the preoperative and postoperative Vaizey scores. Altemeiers procedure had in our series low complications rate and no mortality. Seminars in Colon and Rectal Surgery WB Saunders. The Altemeiers procedure is an available low risk treatment that can be performed under regional anesthesia, recovery is rapid and it gives immediate relief of the prolapse itself. Major complication occurred in only one patient that was pneumonia with lung failure. 1971;173(6):993. https://fascrs.org/patients/diseases-and-conditions/a-z/rectal-prolapse-expanded-version. 1Department of Colorectal Surgery. This repair is typically reserved for those who are not candidates for open or laparoscopic repair. Post-operative complications at 30days occurred in 18 patients (38%): these were classified as Clavien-Dindo grade 1 in 14 patients (78%), grade 2 in 3 patients (17%), grade 3 in zero, and grade 4 in only one patient (5%). The high rate of recurrence at four years from surgery is likely to be multifactorial. Altemeier WA, Culbertson WR, Schowengerdt C, Hunt J. Nineteen years' experience with the one-stage perineal repair of rectal prolapse. One patient showed an improvement in urinary retention but in all other patients the score was unchanged (p=1.000). . There was no post-operative mortality at 30days. Altemeiers procedure can be carried out under spinal anesthesia, avoiding the trauma of a laparotomy and permitting rapid recovery of alimentary function and mobility. Cite this article. CAS These findings support the results obtained in the present study which included a rate of major complications of 2.3% (one patient), which were not related to the ASA score, BMI or age, and no 30days mortality. Experience with the one-stage perineal repair of rectal prolapse. FOIA No.:CD001758. 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. Color Dis. Clinical practice guidelines for the treatment of rectal prolapse. 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]. Data on 43 consecutive female patients undergoing Altemeiers procedure for complete rectal prolapse were reviewed. Altemeier's procedure is one of the well-known peri-neal operations to treat full-thickness rectal prolapse; itremoves the prolapse without a pexy and performs onlya partial reconstruction of the pouch of Douglas. 1984;7(6):37681. Kimmins MH, Evetts BK, Isler J, et al. Ramanujam PS, Venkatesh KS, Fietz MJ. 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.
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