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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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  • 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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  • The patient should be managed in the hospital postoperatively, with attention paid to fluid balance and gastrointestinal function.
  • Standard postcolectomy perioperative care principles apply.
  • Patients are usually maintained on intravenous fluids only with nothing by mouth for the initial 24–48 hours or until there is return of bowel function.
  • Epidural or patient-controlled analgesia is appropriate.

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Perineal Rectosigmoidectomy (Altemeier Procedure)

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  • Patients should have minimal pain.
  • The patient should be monitored in the hospital postoperatively with attention paid to bowel function.
  • Nothing should be inserted per rectum.
  • The diet is advanced as tolerated.
  • The patient may use sitz baths three times daily and after all bowel movements.
  • Stools softeners should be used to keep stools from becoming hard and disrupting the anastomotic suture line.
  • Digital rectal examination should be deferred and no rectal suppositories should be given in the first 2–4 weeks postoperatively.

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Resection Rectopexy

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  • Mortality rate of 0% in all but one published study (which had one death in 15 patients for a 6.7% mortality rate).
  • Recurrence rates range from 0–5%.
  • Postoperative constipation rates range from 18–80% in reported surgical series.
  • Incontinence may not improve with the procedure.

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Perineal Rectosigmoidectomy (Altemeier Procedure)

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  • Mortality rate of 0% in all studies except one (which had one death in 20 patients for a 5% mortality rate).
  • Rectal prolapse recurrence rate is higher with the Altemeier procedure than with resection rectopexy, ranging from 0–16%.
  • Bowel injury can occur upon entering the hernia sac in the anterior plane of dissection, particularly when the patient is in the lithotomy position.

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