Barbato, D

Sorrentino, P

Vincenti, R

English

PubMed

D Barbato

P Sorrentino

R Vincenti

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BMC Geriatrics

Rectal prolapse: mechanical resection sec. altemeier (Reverse Transtar)

Vincenti R

Sorrentino P

Barbato D

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MEETING ABSTRACT Open Access
Rectal prolapse: mechanical resection sec.
altemeier (Reverse Transtar)
D Barbato, P Sorrentino*, R Vincenti
From XXIII Annual Meeting of the Italian Society of Geriatric Surgery
Lecce, Italy. 2-4 December 2010
Background
The recent literature confirms that perineal rectosigmoi-
dectomy sec. Altemeier in the case of a full-thickness
rectal prolapse represents, to the state, the procedure of
choice even if burdened by a relatively high recurrence
rate. Some authors oppose the transabdominal rectopexy
to the perineal resection with or without resection of
the sigma, with or without the aid of prosthesis, sustain-
ing the Altemeier cause of fecal incontinence.
Materials and methods
Our experience includes eight women with a mean age
of 74 aa, with full-thickness rectal prolapse from 8 cm
to around 16 cm, all burdened by incontinence to liquid
stools, in absence of systemic or associated organ
pathologies.
Patients are submitted to colonoscopy, anorectal
manometry and 3D-endoanal ultrasonography.
The colonoscopy was, in all the examined cases, nega-
tive for a greater pathology.
Regarding the manometry the preoperative remaining
pressure of anal canal (RP) was close to zero with a
total absence of rectoanal inhibitory reflex (RAIR). In
the manometry after PNE the average of the remaining
pressure was 45 cm H2O with recurrence of rectoanal
inhibitory reflex (RAIR).
The ultrasound in all the cases showed the thinning of
the sphincterial apparatus.
All patients underwent (for 30 days) temporary percu-
taneous nerve evaluation (PNE). During this period all
the patients solved the external prolapse, also recovering
continence of gas but reporting the onset of obstructed
defecation. Between 1 and 2 months after the end of the
neuromodulation the patients were operated on.
The technique of choice was a purely mechanical
resection sec. Altemeier, through the use of a stapler
Contour Transtar (with the help of 5-7 refills) and GIA.
The resection was deliberately set at about 2 cm from
the anal-rectal junction because we think that leaving
only all the perceptive mucosa the patients may con-
tinue to have control of defecation.
Results
With regard to the state of the patient, after a median
follow-up of 1 year (2 months-1.2 years) no patient had
recurrent prolapses but, above all, reported total anal
continence. There were no postoperative complications
such as postoperative hemorrhages, abdominal infec-
tions, or anastomotic leakages.
Conclusions
The mechanical resection sec. Altemeier (Reverse Trans-
tar) presents a low risk of mortality and immediate
complications, even in elderly patients. Functional
results and a long-term recurrence rate must be investi-
gated further.
Published: 24 August 2011
doi:10.1186/1471-2318-11-S1-A2
Cite this article as: Barbato et al.: Rectal prolapse: mechanical resection
sec. altemeier (Reverse Transtar). BMC Geriatrics 2011 11(Suppl 1):A2.
* Correspondence: sorrentino.piero@tin.it
UOC di Chirurgia Generale - Ospedale Fatebenefratelli Napoli, Italy
Barbato et al. BMC Geriatrics 2011, 11(Suppl 1):A2
http://www.biomedcentral.com/1471-2318/11/S1/A2
© 2011 Barbato et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.


http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3194345

Rectal prolapse: mechanical resection sec. altemeier (Reverse Transtar)

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