Laparoscopic implementation of the Altemeier procedure for recurrent rectal prolapse. Technical note

Strangulated recurrent rectal prolapse after a Delorme intervention, a case report

A surgeon must be aware of indications of rectal prolapse surgery with proper preoperative evaluation and have the ability to recognize complications. Sigmoid redundancy might lead to early recurrence, which itself could complicate into strangulation. Complications per say might require more drastic measures, as Hartmann's procedure in this case.

Laparoscopic-Assisted Altemeier's Procedure for Recurrent Strangulated Rectal Prolapse: A Case Report

Patient: Female, 39

Final Diagnosis: Recurrent strangulated rectal prolapse

Symptoms: Chronic constipation • painful rectal mass • irreducible rectal prolapse

Medication: —

Clinical Procedure: Operation

Specialty: Surgery

A systematic review of the literature on the surgical management of recurrent rectal prolapse

AIM

There are no available guidelines to support surgical decision-making in recurrent rectal prolapse. This systematic review evaluated the results of abdominal or perineal surgery for recurrent rectal prolapse, with the aim of developing an evidence-based treatment algorithm.

METHOD

PubMed and MEDLINE databases were searched for all clinical studies involving patients who underwent surgery for recurrent rectal prolapse between 1950 and 2014. The primary outcome measure was the recurrence rate after abdominal or perineal surgery for recurrent rectal prolapse. Secondary outcomes included morbidity, mortality and quality of life data where available.

RESULTS

There were no randomized controlled studies comparing the success rates of abdominal or perineal surgery for recurrent rectal prolapse. Most studies were heterogeneous, of low quality (level IV) and involved small numbers of patients. The follow-up of 144 patients included in the studies undergoing perineal surgery ranged from 8.8 to 81 months, with recurrence rates varying from 0% to 50%. Morbidity ranged from 0% to 17% with no mortality reported. Limited data on quality of life following the Altemeier procedure were available. The follow-up for 158 patients included in the studies who underwent abdominal surgery ranged from 0 to 23 years, during which recurrence rates varied from 0% to 15%. Morbidity rates ranged from 0% to 32% with 4% mortality. No quality of life data were available for patients undergoing abdominal surgery.

CONCLUSION

This systematic review was unable to develop a treatment algorithm for recurrent rectal prolapse due to the variety of surgical techniques described and the low level of evidence within heterogeneous studies. Larger high-quality studies are necessary to guide practice in this difficult area.