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Review
, 30 (1), 12-15

Perineal Approaches to Rectal Prolapse

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Review

Perineal Approaches to Rectal Prolapse

Louis R Barfield. Clin Colon Rectal Surg.

Abstract

Full-thickness rectal prolapse is a painful and debilitating condition that often responds well to surgical intervention. The best method of surgical repair is a matter of debate. Historically, perineal approaches have been thought to have inferior outcomes and were therefore reserved for elderly and unfit patients. Despite recent data calling that into question, perineal approaches are still commonly performed and have their role. We present risks and benefits along with a description of perineal approaches for surgical treatment of rectal prolapse.

Keywords: Altemeier; Delorme; Thiersch; rectal prolapse; rectosigmoidectomy.

Figures

Fig. 1
Fig. 1
Perineal rectosigmoidectomy (Altemeier). (a-c) Full-thickness excision of the outer cylinder of the prolapse. (d) Mesenteric vessels ligated; stay sutures placed in distal edge of inner cylinder. (e) Anastomosis of the distal aspect of the remaining colon to the rectal stump. (From Whitlow CD. Rectal prolapse and intussusception. In: Beck DE, ed. Handbook of Colorectal Surgery. St Louis, MO: Quality Medical Publishing; 1997:274–298.)
Fig. 2
Fig. 2
Anal encirclement (Thiersch). (a) Lateral incision with prosthetic mesh tunneled around the anus. (b) Mesh completely encircling the anal opening. (c) Completed anal encirclement procedure. (From Whitlow CB. Rectal prolapse and intussusception. In: Beck DE, ed. Handbook of Colorectal Surgery. St Louis, MO: Quality Medical Publishing; 1997:274–298.)

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