Modified Altemeier procedure for incarcerated rectal prolapse--A Case Series

Abstract

Abstract Background: Intrusive rectal prolapse is a rare emergency condition. Despite the numerous surgical options available, the clinical outcome is not promising. Objective：To explore the efficacy of modified Altemeier procedure in the treatment of incarcerated rectal prolapse. Design:We conducted a follow-up study of 12 patients with impaction rectal prolapse. Settings:This study was conducted at a tertiary referral center. Patients:A total of 12 patients with impaction rectal prolapse were included in this study. All cases were treated with emergency surgery because of failed conservative treatment.A total of 12 patients, 11 males, and 1 female, were included in this study. Age was 24-82 (Med42.08±MD15.95) years, previous medical history was 3-40 (Med19.92±MD13.43) years, and time from onset to admission was 0.5-26 (Med7.96±MD8.03) h. Interventions:Modified Altemeier procedure was performed in all cases. Main outcome measures:The primary outcomes included Mortality, complication rates, time and severity of postoperative recurrence, changes in pre- and postoperative Wexner anal incontinence scores and ED-5Q-5L quality-of-life autonomy scores. Secondary outcomes included operative time, intraoperative bleeding, and length of hospital stay. Results:During the 24-month follow-up period, no death or recurrence was observed in any of the patients. There was only one case of hemorrhage from the anastomosis on the fourth postoperative day, and the patient was discharged after receiving emergency suturing to control the bleeding. At the same time, all patients' quality of life scores dramatically increased and the postoperative Wexner anal incontinence scores were significantly lower.Finally,The intraoperative bleeding volume was 15-20 (Med20.83±SD7.71) ml; the operative time was 140-260 (Med172.50±SD57.70) min; and the hospital stay was 6-44 (Med16.75±SD9.61) d. Limitation:First, embedded rectal prolapse has an acute onset and requires emergency surgery, so there is a lack of objective indicators such as preoperative and postoperative anal manometry; second, this disease is extremely rare and few cases were included in this study; finally, this study is a retrospective clinical study and may be biased. Conclusions: The mortality, ecurrence rate, complication rates after the modified Altemeier procedure were better than the results of previous studies, which showed that this modified procedure was effective in reducing the mortality and complication rates of impaction rectal prolapse. At the same time, patients showed significant improvement in preoperative and postoperative anal function and quality of life, but the length of hospital stay was longer than previously reported in the literature.