Rectal prolapse in older patients with significant comorbidities presents a distinct clinical challenge. The presence of multiple comorbidities shapes both the choice of surgical approach and the expectations for functional recovery.
Older patients with significant comorbidities who develop rectal prolapse are generally not considered suitable candidates for transabdominal repair. This patient profile — characterised by age and a higher burden of comorbid conditions — typically directs management toward a perineal surgical approach.
A perineal rectosigmoidectomy — the Altemeier procedure — is the surgical strategy considered for this population. The full protocol specifies the complete procedural criteria, technique details, and additional operative considerations relevant to this patient group.
The primary aims of surgical correction are elimination of the rectal prolapse and correction of associated functional abnormalities, including constipation or incontinence.
DOI: 10.1097/DCR.0000000000000889
Generally speaking, patients undergoing perineal rectosigmoidectomy are older, with significantly more comorbidities than those who are considered for transabdominal repair.
Rectal prolapse may be treated with a perineal rectosigmoidectomy.
Perineal rectosigmoidectomy, the Altemeier procedure, involves a transanal full-thickness resection of the prolapsed rectum and a coloanal anastomosis.
The goals of surgery to correct rectal prolapse are 3-fold: 1) to eliminate the prolapse through either resection or restoration of normal anatomy, 2) to correct associated functional abnormalities of constipation or incontinence, and 3) to avoid the creation of de novo bowel dysfunction.
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