A comparison of perineal stapled rectal prolapse resection and the Altemeier procedure at 2 Canadian academic hospitals

• Published in: Canadian Journal of Surgery 2021-12, Vol.64, p.S133-S133
• Main Authors: Roy, H, Baig, Z, Karimmudin, A, Raval, M, Brown, C, Phang, T, Gill, D, Ginther, N
• Format: Article
• Language: English
• Subjects: Surgical outcomes
• ISSN: 0008-428X; 1488-2310

Background: Traditionally, the perineal repair of choice for full thickness rectal prolapse has been the Altemeier procedure, a perineal proctosigmoidectomy with a handsewn anastomosis. A recently described variant of this procedure combines the resection and anastomosis into 1 step by means of linear and transverse stapling. There are few published data comparing the characteristics and outcomes of these 2 approaches. Methods: This retrospective review, performed at 2 Canadian academic hospitals, performed a surgical outcomes and cost comparison between the perineal stapled prolapse resection and the Altemeier procedure. All patients undergoing perineal stapled prolapse resection (2 5) and the Altemeier procedure (19) between 2015 and 2019 were included. Results: The perineal stapled prolapse resection group was significantly older than the Altemeier group (81 yr, 95% confidence interval [CI] 70-92 yr v. 74 yr, 95% CI 63-85 yr; p = 0.047), with a lower body mass index (21.4, 95% CI 17.7-25.1 v. 24.4, 95% CI 18.5-30.3; p = 0.042) and equivalent American Society of Anesthesiologists score (2.84, 95% CI 2.09-3.59 v. 2.68, 95% CI 1.93-3.43; p = 0.49). The operative time for perineal stapled prolapse resection was significantly less (30.3 min, 95% CI 16.3-44.3 min v. 67 min, 95% CI 43-91 min; p < 0.001), as were the operative costs. Recurrence (28% v. 37%; p = 0.53) and complication rates were equivalent. Conclusion: Perineal stapled prolapse resection is a safe, efficient and effective approach to perineal proctosigmoidectomy, with surgical outcomes comparable to those associated with the Altemeier procedure, but with a significant reduction in operative time and cost.