The Delorme operation involves mucosal stripping and muscle plication of the rectal prolapse and is performed externally under regional or general anesthesia. Seventy-five patients (93 % female) underwent rectal prolapse surgery: 22 Altemeier and 53 Delorme, mean age 72 ± 15 years. The indication of surgical treatment was the patient’s distress related to complete rectal prolapse in the entire patient. Altemeier perineal rectosigmoidectomy for rectal prolapse. In a study of 32 patients with external rectal prolapse, Hetzer et al concluded that perineal stapled prolapse resection is a fast and effective treatment for this condition. Sixty-six percentage of patients were ASA grade III or IV (Table 1). Aim: The study assesses long-term outcomes after Delorme’s procedure … Perineal rectosigmoidectomy for rectal prolapse. Objective: To evaluate the quality of life after Altemeier and Delorme procedures for rectal prolapse patients.Methods: A retrospective cohort study was performed. The median hospital stay was longer in Altemeier’s group [4 (1–44) days vs. 3 (0–14) days; p = 0.01]. Altemeier procedure had higher rate of major (grade III-IV) complications compared to Delorme and PSR (39.7% Vs 8.7% and 16.3%). INDICATIONS This 74-year-old female has been dealing with what she thought was hemorrhoids for several years off and on. The Altemeier’s Operation Altemeier’s operation (perineal rectosigmoidectomy) is a surgical procedure used to correct a full-thickness rectal prolapse. 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). ANESTHESIA General endotracheal anesthesia. Vaizey incontinence, bowel function and EQ‐5D score improved from baseline to 6 weeks with this improvement maintained at 1 and 3 years but with no apparent differences between the two surgical procedures (Table 2). 15 However, both postanal repair and sphincteroplasty are more morbid and time consuming than placing a simple Thiersch suture. Delorme Procedure 21. The choices can be broadly categorized into three types: (a) sigmoid resection with rectopexy (Frykman-Goldberg procedure), (b) rectopexy with or without mesh, and (c) perineal approaches including perineal rectosigmoidectomy (Altemeier procedure) or rectal mucosectomy and plication (Delorme procedure). Sixty-six percentage of patients were ASA grade III or IV (Table 1). Table 7 lists patients undergoing the Delorme operation, with reported mortality rates of 0% to 4% and recurrence rates of 4% to 38%. This is a modification of the perineal rectosigmoidectomy, differing in that only the mucosa and submucosa are excised from the prolapsed segment, rather than full thickness resection. The operations were performed by four colorectal surgeons (A, B, C, and D). This is done via the anus. Altemeier procedure, perineal proctosigmoidectomy. Pescatori et al described improved function after Delorme’s procedure with sphincteroplasty 21 and Calata et al have successfully used a biological mesh in combination with an Altemeier procedure. Delorme Procedure. Delorme Procedure 20. 6 • Patients were followed for a median of 36 months . The management of the recurrent prolapse was as follows: No further intervention (n = 1), repeat Delorme’s procedure (n = 3), Altemeier’s procedure (n = 5) and rectopexy with faecal diversion (n = 3). One patient was lost during follow up. Procedure performed by Tracy Arnell, MD, ColumbiaDoctors, New York, NY. Primary outcome measures were recur-rence of the prolapse, incontinence, bowel function and quality of life scores (Vaizey, bowel thermometer and The PROSPER trial randomized 23 patients to abdominal procedures (suture posterior rectopexy and posterior rectopexy with resection) and 26 patients to perineal procedures (Altemeier and Delorme). Perineal vs abdominal approaches • Found higher recurrence rates for suture rectopexy vs resection rectopexy (46% vs 18%), but was not statistically significant Overall, recurrence rates did not differ significantly between the perineal and abdominal approaches (20 vs. 26%, P = 0.8). This operation involves the surgeon remov-ing some of the prolapsed lining of the rectum (mucosa) and reinforcing the muscle of the rectum by placating stitches. Altemeier Procedure 19. (See also the American Society of Colon and Rectal Surgeons' clinical practice guidelines for the treatment of rectal prolapse.) Altemeier's vs Delorme's procedure. Short-term outcomes and QOL were compared.Seventy-five patients (93% female) underwent rectal prolapse surgery: 22 Altemeier and 53 Delorme, mean age 72 ± 15 years. Delorme’s perineal repair has remained a procedure reserved for full-thickness rectal prolapse in elderly or co-morbid patients due to its low morbidity and complications. Reported recurrence rates are higher than in abdominal approaches. The Altemeier procedure revealed the most significant impact on the function of the anal sphincter muscles and resting pressures (42 ± 7 vs 53 ± 9 cm H2O; p = 0.0082). No external incision is needed. Altmeier for rectal prolapse published in ASCRS text book Video Created by Jeff Mino, Brooke Gurland, Massarat Zutshi, Tracy Hull perineal surgery (i), and suture vs resection rectopexy for those receiving an abdominal procedure (ii) or Altemeier’s vs Delorme’s for those receiving a perineal procedure (iii). She says she has pain and rectal bleeding. The original Altemeier procedure also entails restoration of the pelvic floor, by means of an additional levatorplasty . Patients were randomized between abdominal and perineal surgery (1), and suture vs resection rectopexy for those undergoing an abdominal procedure (2), or the Altemeier procedure vs the Delorme procedure for those having a perineal procedure (3). Peri-operative data on 43 consecutive female patients were reviewed. Educational step-by-step video provided by MovieSurg. Short-term outcomes and QOL were compared. Both procedures may be performed under general, spinal, or local anesthesia with the patient in prone-jackknife, lithotomy, or left lateral decubitus positions. A Delorme’s procedure aims to repair the prolapse. Short-term outcomes and QOL were compared.Seventy-five patients (93% female) underwent rectal prolapse surgery: 22 Altemeier and 53 Delorme, mean age 72 ± 15 years. The APs included open Altemeier vs Delorme procedure. We report our experience with this procedure in six elderly candidates who have undergone the Delorme procedure at the UCLA Center for Health Sciences in the past year. Both of these techniques are time-consuming, and Delorme’s procedure has a high … 56,57,82,84,86-88 Oliver et al 86 successfully performed the Delorme procedure in 41 patients with a mean age of 82 years who were deemed unfit for major surgery because of age or comorbidity. Delorme Procedure 22. The prolapse is exposed if it is not already present, and the mucosal and submucosal layers are stripped from the redundant length of bowel. The most common complication after Altemeier procedure was anastomotic leakage (1.88%). Mucosal sleeve resection, as described by Delorme in 1900, involves stripping the mucosa from the redundant rectum and plicating the denuded rectal wall with sutures to create bulk and thus prevent future prolapse. 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. Altemeier Procedure. The remaining structures that help support the rectum are stitched back together in an attempt to provide better support. Tjandra JJ, Fazio VW, Church JM et al (1993) Ripstein pro- to perineal rectosigmoidectomy is superior to perineal cedure is an effective treatment for … If anterior levatoroplasty was added, the benefits referred also to squeeze pressures (41 ± 8 vs 58 ± 9 cm H2O; p = 0.006 and 42 ± 10 vs 56 ± 9 cm H2O; p = 0.01). The hernia sac is entered, and the prolapse is delivered. Altemeier perineal rectosigmoidectomy. In an Altemeier perineal rectosigmoidectomy, a full-thickness circumferential incision is made in the prolapsed rectum about 1-2 cm from the dentate line (see the image below). Sixty-six percentage of patients were ASA grade III or IV (Table 1). In patients who cannot tolerate a laparotomy, perineal operations (eg, Delorme or Altemeier procedure) can be considered. There are two RCTs assessing the abdominal vs. perineal approach. In this procedure, the portion of the rectum extending out of the anus is removed or excised and the two ends are sewn back together. Delorme’s procedure and the Altemeier operation are the most popular perineal techniques for rectal prolapse in patients who are not suitable candidates for abdominal procedures. Furthermore, incontinence, bowel function and QOL were similar between groups. The recurrence rates were similar for Altemeier’s procedure and Delorme’s procedure (24 vs. 31%, P = 0.4). Delorme’s procedure involves a circular excision of the mucosa and plication of rectal wall muscle [15, 16]. There were three patients who developed an early recurrence, within two weeks of the initial procedure. More Information procedure (PP) (n = 40). The median hospital stay was longer in Altemeier’s group [4 (1–44) days vs. 3 (0–14) days; p = 0.01]. The recurrence rate in younger (<50 y) Delorme patients is comparable with historical rates associated with abdominal repairs, but with a more favorable risk profile. the Altemeier procedure. Clinical data of patients with full-thickness rectal prolapse undergoing surgical treatment in the Sixth Affiliated Hospital, Sun Yat-sen University from February 2013 to January 2018 were retrospectively analyzed. The two most commonly performed perineal-based procedures are the Altemeier procedure and the Delorme procedure. Altemeier (posterior rectosigmoidectomy) procedure for rectal prolaps. Thiersch Procedure 23. The Delorme group in general has outcomes comparable with historical Altemeier procedure outcomes without the risk of a full-thickness anastomosis. The median hospital stay was longer in Altemeier’s group [4 (1–44) days vs. 3 (0–14) days; p = 0.01]. The appearance of circumferential, concentric folds of Thiersch wire procedure), mucosal sleeve resection (the Delorme rectal mucosa serves to differentiate rectal prolapse from hemor- procedure), and perineal rectosigmoidectomy (the Altemeier pro- rhoids, in which the folds (sulci) occur in a radial pattern, yield- cedure). Dis Colon Rectum 27:376–381 This study confirms that the addition of levator repair 6. Altemeier procedure is also called a perineal proctosigmoidectomy.
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