1. Introduction

a. Patient Positioning

b. Preoperative Exam and Delivery of Prolapse

c. Exposure with Retractor

d. Examine Anatomy and Score Dissection Line Around Rectum

e. Inject Local Anesthetic Along Score Line for Hemostasis

2. Patient Preparation

3. Full-Thickness Rectal Dissection to the Mesentery on the Inside

a. Make Windows into Mesentery and Divide with LigaSure to Deliver More Rectum

4. Evert Rectum to See Entire Rectal Edge

5. Open Pouch of Douglas to Enter Abdominal Cavity

6. Inspect Sigmoid Colon and Determine Level of Resection

7. Posterior Levatorplasty

8. Close Pouch of Douglas

9. Transection

10. Complete Anastomosis

11. Inject Marcaine for Pudendal Nerve Block

12. Examination of Specimen

13. Post-op Remarks

Full-thickness rectal prolapse occurs when the rectum invaginates into the anal canal and beyond the anal sphincters. It is estimated to occur in 2.5 per 100,000 people, and most commonly affects women, particularly elderly women with other pelvic floor disorders. The only definitive treatment for rectal prolapse is surgery. In this case, we present an 80-year-old female with full-thickness rectal prolapse who underwent Altemeier proctosigmoidectomy. The redundant rectum is delivered and then excised through a transanal approach, and the proximal colon is sutured to the distal end of the rectum.

Watch this full-length, narrated surgical video of an Altemeier perineal proctosigmoidectomy for rectal Prolapse performed by Dr. Brooke Gurland at Stanford University

Stanford University Medical Center