Objective: The aim of this study was to evaluate the long-term results of perineal rectosigmoidectomy. Background: Multiple surgical options are available for rectal prolapse Perineal rectosigmoidectomy (Altemeier's procedure) is the procedure of choice in elderly patients and those with multiple comorbidities. Methods: Retrospective review was performed of all patients undergoing perineal rectosigmoidectomy from 1998-2008. Results: Of 128 patients, 125(98%) were women; with mean age 74 yrs. Mean operating time was 76 minutes. Hemostasis was achieved using Ultrasonic scalpel or clamp and tie technique in equal numbers. Ultrasonic scalpel use resulted in shorter operative times (57.9 vs. 94.7 minutes, respectively, p< 0.0001,) and estimated blood loss (18.8 vs. 73 ml, respectively, p <0.0001,) compared to clamp-tie technique. Recurrence was seen in 23(18%) patients. Recurrence was more after a hand-sewn anastomosis compared to a stapled anastomosis. Complications occurred in 3 patients (2%)(1-major bleeding, 1-perineal abscess, and 1-post-operative ileus). Conclusions: Perineal rectosigmoidectomy is associated with low morbidity and mortality. In addition the minimal discomfort to patient, short length of stay and improvement in quality of life makes this a suitable operation for the elderly.

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