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Beverly Hills · 435 N. Bedford Dr., Suite 308Mon–Fri 9:00 am – 5:00 pmMost PPO insurance accepted
Allen KamravaMD · MBA · FACS · FASCRS

Procedure

Rectal Prolapse Repair (Perineal Delorme / Altemeier / Abdominal Rectopexy)

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1-4 weeks
Success rate
70-95%
Recurrence
5-30%

What it is

What is Rectal Prolapse Repair?

Surgical repair is the definitive treatment for full-thickness rectal prolapse. The choice of procedure depends on the patient's age, overall health, and the surgeon's expertise. The goal of surgery is to correct the anatomical defect, restore normal bowel function, and improve quality of life. The main approaches are abdominal or perineal.

Abdominal Repair (Rectopexy)

Abdominal repairs are most commonly performed using minimally invasive techniques (laparoscopic or robotic surgery). The procedure involves mobilizing the rectum from the pelvis and fixing it (a 'pexy') to the sacral promontory, often using sutures or a piece of mesh to prevent it from telescoping. This procedure is frequently combined with a sigmoid resection if the patient has significant constipation and a redundant colon.

Perineal Repairs

Perineal procedures are performed through an incision around the anus and are generally reserved for older, frail patients as they avoid the stress of an abdominal operation.

Altemeier Procedure (Perineal Rectosigmoidectomy)

This procedure involves pulling the prolapsed rectum and a portion of the sigmoid colon out through the anus, resecting the redundant bowel, and creating a new connection (anastomosis) between the remaining colon and the anal canal.

Delorme Procedure (Mucosal Sleeve Resection)

This procedure is suitable for shorter prolapses. It involves stripping the inner mucosal lining from the prolapsed rectum, plicating (folding and suturing) the underlying rectal muscle wall to shorten it, and then reattaching the mucosa at the top of the anal canal.

Am I a candidate?

Who is a Good Candidate for These Procedures?

The choice between an abdominal and a perineal approach is highly individualized.

  • Abdominal Rectopexy: This is generally the preferred approach for younger, healthier patients who can tolerate a longer operation under general anesthesia. It is associated with the lowest rates of recurrence and is often chosen for patients who are sexually active and concerned about functional outcomes.
  • Perineal Procedures (Altemeier and Delorme): These procedures are typically reserved for older, frail patients with significant medical comorbidities who may be poor candidates for an abdominal operation. They are associated with less operative morbidity and a faster recovery but have a significantly higher rate of recurrence.

Recovery

What is the Recovery Like?

Recovery varies significantly between abdominal and perineal approaches.

  • Abdominal Rectopexy: Recovery is generally longer. A hospital stay of 1 to 3 days is typical with minimally invasive surgery. A return to normal, non-strenuous activities can be expected within 2 to 4 weeks. Heavy lifting should be avoided for at least 6 weeks.
  • Perineal Procedures: Recovery is typically faster, although there can be more initial perineal pain. The hospital stay may be shorter, and patients often return to normal activities within 1 to 2 weeks. It is crucial to maintain soft stools to avoid straining during the healing period.

Risks & considerations

What are the Risks?

All surgical procedures for rectal prolapse carry general risks such as bleeding, infection, and anastomotic leak (if a resection is performed). Risks specific to each approach include:

  • Abdominal Rectopexy: The primary risks are related to the pelvic dissection and include injury to the pelvic autonomic nerves, which can lead to new or worsened constipation or sexual dysfunction. If mesh is used, there is a small risk of mesh erosion into the rectum or vagina and infection, though this is rare with modern techniques.
  • Perineal Procedures: The main risk of perineal repairs is a higher rate of prolapse recurrence compared to abdominal approaches. There is also a risk of temporary or permanent fecal incontinence and, with the Altemeier procedure, a risk of anastomotic leak at the coloanal connection.

Sources

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