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Mantzoros I, Brenta A, Bourtzinakou AA, Kontaxi O, Gemousakakis G, Antoniou N, Bitsianis S, Kotidis E, Kyziridis D, Ioannidis O, Kerasidou O, Gkiouliava A, Pramateftakis M, Aggelopoulos S. Perineal Rectosigmoidectomy (Altemeier's Procedure) in the Treatment of Strangulated Rectal Prolapse: A Case Series and Literature Review. J Pers Med 2024; 14:1095. [PMID: 39590587 PMCID: PMC11595259 DOI: 10.3390/jpm14111095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 10/14/2024] [Accepted: 10/25/2024] [Indexed: 11/28/2024] Open
Abstract
BACKGROUND Rectal prolapse (RP) predominantly affects women over the age of 50 and presents as mucosal, internal, or full thickness prolapse. Strangulated rectal prolapse requires immediate medical intervention, and surgical treatment options include both abdominal and perineal approaches. We aim to present a case series of perineal rectosigmoidectomy performed urgently due to strangulation and argue that Altemeier's procedure is the preferred method for treating strangulated rectal prolapse. METHODS Perineal rectosigmoidectomy, particularly Altemeier's procedure, is effective for incarcerated cases. Altemeier's procedure with diverting ileostomy was used in all three patients. RESULTS All patients were successfully treated, with no recurrence of prolapse and stool incontinence. CONCLUSIONS Altemeier's procedure is ideal for the treatment of strangulated rectal prolapse.
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Affiliation(s)
- Ioannis Mantzoros
- 4th Department of Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (I.M.); (A.-A.B.); (O.K.); (G.G.); (S.B.); (E.K.); (D.K.); (O.I.); (O.K.); (M.P.); (S.A.)
| | - Aliki Brenta
- 4th Department of Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (I.M.); (A.-A.B.); (O.K.); (G.G.); (S.B.); (E.K.); (D.K.); (O.I.); (O.K.); (M.P.); (S.A.)
| | - Aikaterini-Antonia Bourtzinakou
- 4th Department of Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (I.M.); (A.-A.B.); (O.K.); (G.G.); (S.B.); (E.K.); (D.K.); (O.I.); (O.K.); (M.P.); (S.A.)
| | - Ourania Kontaxi
- 4th Department of Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (I.M.); (A.-A.B.); (O.K.); (G.G.); (S.B.); (E.K.); (D.K.); (O.I.); (O.K.); (M.P.); (S.A.)
| | - Georgios Gemousakakis
- 4th Department of Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (I.M.); (A.-A.B.); (O.K.); (G.G.); (S.B.); (E.K.); (D.K.); (O.I.); (O.K.); (M.P.); (S.A.)
| | - Nikolaos Antoniou
- 2nd Department of Surgery, General Hospital of Thessaloniki “G. Gennimatas”, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece;
| | - Stefanos Bitsianis
- 4th Department of Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (I.M.); (A.-A.B.); (O.K.); (G.G.); (S.B.); (E.K.); (D.K.); (O.I.); (O.K.); (M.P.); (S.A.)
| | - Efstathios Kotidis
- 4th Department of Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (I.M.); (A.-A.B.); (O.K.); (G.G.); (S.B.); (E.K.); (D.K.); (O.I.); (O.K.); (M.P.); (S.A.)
| | - Dimitrios Kyziridis
- 4th Department of Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (I.M.); (A.-A.B.); (O.K.); (G.G.); (S.B.); (E.K.); (D.K.); (O.I.); (O.K.); (M.P.); (S.A.)
| | - Orestis Ioannidis
- 4th Department of Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (I.M.); (A.-A.B.); (O.K.); (G.G.); (S.B.); (E.K.); (D.K.); (O.I.); (O.K.); (M.P.); (S.A.)
| | - Ourania Kerasidou
- 4th Department of Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (I.M.); (A.-A.B.); (O.K.); (G.G.); (S.B.); (E.K.); (D.K.); (O.I.); (O.K.); (M.P.); (S.A.)
| | - Anna Gkiouliava
- Department of Anesthesiology and Intensive Care, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece;
| | - Manousos Pramateftakis
- 4th Department of Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (I.M.); (A.-A.B.); (O.K.); (G.G.); (S.B.); (E.K.); (D.K.); (O.I.); (O.K.); (M.P.); (S.A.)
| | - Stamatios Aggelopoulos
- 4th Department of Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (I.M.); (A.-A.B.); (O.K.); (G.G.); (S.B.); (E.K.); (D.K.); (O.I.); (O.K.); (M.P.); (S.A.)
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Pellino G, Fuschillo G, Simillis C, Selvaggi L, Signoriello G, Vinci D, Kontovounisios C, Selvaggi F, Sciaudone G. Abdominal versus perineal approach for external rectal prolapse: systematic review with meta-analysis. BJS Open 2022; 6:zrac018. [PMID: 35390136 PMCID: PMC8989040 DOI: 10.1093/bjsopen/zrac018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND External rectal prolapse (ERP) is a debilitating condition in which surgery plays an important role. The aim of this study was to evaluate the outcomes of abdominal approaches (AA) and perineal approaches (PA) to ERP. METHODS This was a PRISMA-compliant systematic review with meta-analysis. Studies published between 1990 and 2021 were retrieved. The primary endpoint was recurrence at the last available follow-up. Secondary endpoints included factors associated with recurrence and function. All studies were assessed for bias using the Newcastle-Ottawa Scale and Cochrane tool. RESULTS Fifteen studies involving 1611 patients (AA = 817; PA = 794) treated for ERP were included, three of which were randomized controlled trials (RCTs; 114 patients (AA = 54; PA = 60)). Duration of follow-up ranged from 12 to 82 months. Recurrence in non-randomized studies was 7.7 per cent in AA versus 20.1 per cent in PA (odds ratio (OR) 0.29, 95 per cent confidence interval (c.i.) 0.17 to 0.50; P < 0.001, I2 = 45 per cent). In RCTs, there was no significant difference (9.8 per cent versus 16.3 per cent, AA versus PA (OR 0.82, 95 per cent c.i. 0.29 to 2.37; P = 0.72, I2 = 0.0 per cent)). Age at surgery and duration of follow-up were risk factors for recurrence. Following AA, the recurrence rates were 10.1 per cent and 6.2 per cent in patients aged 65 years and older and less than 65 years of age, respectively (effect size [e.s.] 7.7, 95 per cent c.i. 4.5 to 11.5). Following PA, rates were 27 per cent and 16.3 per cent (e.s. 20.1, 95 per cent c.i. 13 to 28.2). Extending follow-up to at least 40 months increased the likelihood of recurrence. The median duration of hospital stay was 4.9 days after PA versus 7.2 days after AA. Overall, incontinence was less likely after AA (OR 0.32), but constipation occurred more frequently (OR 1.68). Most studies were retrospective, and several outcomes from RCTs were not consistent with those observed in non-RCTs. CONCLUSION The overall risk of recurrence of ERP appears to be higher with PA versus AA. Incontinence is less frequent after AA but at the cost of increased constipation. Age at surgery and duration of follow-up are associated with increased risk of recurrence, which warrants adequate reporting of future studies on this topic.
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Affiliation(s)
- Gianluca Pellino
- Colorectal Surgery, Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
- Colorectal Surgery, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Giacomo Fuschillo
- Colorectal Surgery, Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Costantinos Simillis
- Cambridge Colorectal Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Lucio Selvaggi
- Colorectal Surgery, Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Giuseppe Signoriello
- Section of Statistic, Department of Experimental Medicine, Università degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Danilo Vinci
- Colorectal Surgery, Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Christos Kontovounisios
- Department of Colorectal Surgery, Royal Marsden Hospital, London, UK
- Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Francesco Selvaggi
- Colorectal Surgery, Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Guido Sciaudone
- Colorectal Surgery, Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
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Trompetto M, Tutino R, Realis Luc A, Novelli E, Gallo G, Clerico G. Altemeier's procedure for complete rectal prolapse; outcome and function in 43 consecutive female patients. BMC Surg 2019; 19:1. [PMID: 30606166 PMCID: PMC6318906 DOI: 10.1186/s12893-018-0463-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 12/18/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The aim of this retrospective study was to evaluate morbidity, mortality, postoperative function and recurrences in patients treated by Altemeier's rectosigmoidectomy for complete rectal prolapse in a referral center for pelvic floor functional disorders. METHODS Peri-operative data on 43 consecutive female patients were reviewed. At follow-up any change in pelvic floor function and recurrences were determined. Thirty four patients were assessed at a median interval of 49 (2-135) months, six being deceased for reason not related to the prolapse and three lost to follow-up. RESULTS Post-operative complications at 30 days occurred in 18 patients (38%). Major complication occurred in only one patient that was pneumonia with lung failure. Major complications were not related to the ASA score, BMI or age [average age 76.4]. There was no post-operative mortality at 30 days. At long-term follow-up functional results demonstrate a statistically significant decrease in the Obstructive Defecation Syndrome (ODS) score, but no statistically significant changes in the Vaizey score, the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) score and the urinary retention score. ODS score decreased with respect to levatorplasty and the change was statistically significant instead of Vaizey score in which were not. At the same follow-up there were 12 (35%) cases of recurrence with an estimated risk at 48 months of 40%. 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). Patient satisfaction showed a mean of 8.8 and 6.4 respectively in patients without and with recurrences (p = 0.012). CONCLUSIONS Altemeier's procedure had in our series low complications rate and no mortality. It offered improved evacuation in constipated patients while didn't improve fecal and urinary continence. Recurrence of prolapse was 40% at four years.
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Affiliation(s)
- Mario Trompetto
- Department of Colorectal Surgery. S Rita Clinic, Vercelli, Italy
| | - Roberta Tutino
- Department of Colorectal Surgery. S Rita Clinic, Vercelli, Italy
- Dept. of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | | | - Eugenio Novelli
- Department of Biostatistics, S.Gaudenzio Clinic, Policlinico di Monza, Italy
| | - Gaetano Gallo
- Department of Colorectal Surgery. S Rita Clinic, Vercelli, Italy
- Department of General Surgery, University of Catanzaro, Catanzaro, Italy
| | - Giuseppe Clerico
- Department of Colorectal Surgery. S Rita Clinic, Vercelli, Italy
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Ray A, Mandal KC, Shukla RM, Roy D, Mukhopadhyay B, Bhattacharya M. Neglected intussusception presenting as transanal prolapse of small bowel. Indian J Pediatr 2012; 79:1370-1. [PMID: 22323102 DOI: 10.1007/s12098-012-0692-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Accepted: 01/11/2012] [Indexed: 11/30/2022]
Abstract
Although transanal prolapse of intussusception in infants is well recognized, it is rarely reported and confusion with rectal prolapse often results in delayed diagnosis and treatment. This report highlights the problems of delayed diagnosis and the morbidity and mortality associated with this condition. The authors report a case of 9 mo old boy who presented with prolapsing small bowel mimicking rectal prolapse.
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Affiliation(s)
- Amit Ray
- Department of Pediatric Surgery, Nil Ratan Sircar Medical College and Hospital, Kolkata, India
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Abstract
Rectal prolapse is a troublesome anorectal disorder. Surgical procedures for rectal prolapse contain transabdominal and transperineal approaches. There are hundreds of transabdominal procedures currently available for treatment of the disease, such as Ripstein procedure, Wells procedure, Orr procedure, Nigro procedure, anterior resection, Frykman-Goldberg procedure, and Roscoe Graham procedure. Laparoscopic repair represents the latest advance in surgical treatment of rectal prolapse. As each procedure has its strength and weakness, personalized selection of appropriate procedure can greatly improve surgical outcome. Individualized diagnosis and treatment plan may represent a new direction for transabdominal surgical treatment of rectal prolapse.
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Abstract
Intussusception of the colon usually occurs in infants and children. Although rectal prolapse is not uncommon, presentation of more proximal segments of large bowel through the anus is extremely rare. We report two cases of rectosigmoid intussusception in which sigmoid colon intussusception was diagnosed as rectal prolapse preoperatively.
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