Klinik und Poliklinik für Allgemein-, Viszeral-, Gefäß-
und Kinderchirurgie (Chirurgische Klinik I)
Direktor: Prof. Dr. C.-T. Germer
Risk factors for recurrence in perineal rectosigmoidectomy
M. Kim, J. Reibetanz, N. Schlegel, C.-T. Germer, C. Isbert
No conflicts of interest
Klinik und Poliklinik für Allgemein-, Viszeral-, Gefäß-
und Kinderchirurgie (Chirurgische Klinik I)
Direktor: Prof. Dr. C.-T. Germer
Langzeitergebnisse nach transperinealerRektosigmoidektomie nach Altemeier bei externem
Rektumvollwandprolaps °III
M. Kim, J. Reibetanz, N. Schlegel, C.-T. Germer, C. Isbert
For the therapy of full thickness rectal prolapse
Variety of surgical interventions exist
Abdominal
(laparoscopic vs open, rectopexy vs resectionrectopexy)
Perineal
[Altemeier et al AMA Ann Surg 1952][Altemeier et al. Arch Surg 1964]
Introduction – Perineal rectosigmoidectomy (Altemeier)
Altemeier‘s procedure
Improvement of function and quality of life
Altemeier‘s procedure – Function and Quality of Life
[Kim et al. Br J Surg 2010][Glasgow et al. J Gastrointest Surg 2008]
[Senapati et al. Colorectal Dis 2013][Cirocco et al. Dis Colon Rectum Dis 2010]
[Altomare et al. Dis Colon Rectum 2009]
Altemeier‘s procedure – Recurrence
Recurrence after Altemeier‘s procedure
• 0 – 60% reported recurrence rate vary
• 0 – 18% Monocenter trials
• 20% PROSPER trial (prospective multicenter)
no difference between abdominal procedures
Klinik und Poliklinik für Allgemein-, Viszeral-, Gefäß-
und Kinderchirurgie (Chirurgische Klinik I)
Direktor: Prof. Dr. C.-T. Germer
Langzeitergebnisse nach transperinealerRektosigmoidektomie nach Altemeier bei externem
Rektumvollwandprolaps °III
M. Kim, J. Reibetanz, N. Schlegel, C.-T. Germer, C. Isbert
Aim of this study
Analysis of risk factors for recurrence after Altemeier‘s procedure in
patients with full-thickness rectal prolapse
2004 - 2012
• Number n = 63
• Gender n = 7 male
• Age 79 (30-90) yrs
• ASA I n = 6II n = 30III n = 25IV n = 2
• OP time [mean±SD] 88.8 ± 30.8 min
• Hospital stay [mean±SD] 6.6 ± 3.4 days
• Follow-up [median; range] 53 (3-99) months
Patients and Methods
• Grad I n = 1 partial mucosal necrosis
n = 1 anastomotic dehiscence
• Grad II n = 1 urinary retention
n = 5 urinary tract infection
n = 1 allergic reaction
n = 1 pneumonia
n = 1 tachyarrhythmia
• Grad III A n = 0
• Grad III B n = 1 bleeding
• Grad IV n = 1 myocardial infarction
Results – Morbidity and Recurrence
[Dindo et al. Ann Surg 2004]
• Recurrence n = 8 after 18 (6-43) months
• Follow-up [median; range] 53 (3-99) months
Recurrence No recurrence P
n = 8 n = 55
Age [yrs] 68.5 (18.1) 73.84 (14.8)
Male [n] 1 6
ASA [n] 2.2 (0.07) 2.39 (0.7)
Preop. incontinence [pts] 13.3 (6.76) 12.7 (6.9)
Prolapse anterior compartiment [n] 1 18
Previous pelvic surgery [n] 2 30
Hysterektomy [n] 1 17
OP time [min] 95 (43) 87 (29)
Levatorplasty [n] 5 28
Preop. constipation [pts] 11.9 (6.45) 7.63 (6.3) 0.1
Duration prolapse [mon.; median] 18 (3-732) 6 (1-396) 0.02
Length specimen [cm] 5.97 (1.2) 8.98 (5.07) 0.001
Stapled anastomosis [n] 3 2 0.001
Follow-up [mon] 58.13 (22.2) 50 (23.65)
Results – Risk of Recurrence, univariate
Hazard
Ratio
95% Confidence-
Interval
P
Duration prolapse[≤/> 6 mon] 4.09 0.83 – 20.28 0.06
Length specimen [</≥ 7 cm] 4.06 0.97 - 16.99 0.03
Anastomosis [stapled vs hand] 7.96 1.9 - 33.47 0.001
Results – Risk of Recurrence, multivariate
Type of anastomosis Length resected specimen
Chirurgische Klinik I, Universitätsklinikum Würzburg
Conclusion
Recurrence after Altemeier‘s procedure …
depends on the length of follow-up
is less influenced by patients‘ characteristics
(Age, gender, comorbidities, previous surgery)
but may be influenced by operative techniques
(Length of specimen, kind of anastomosis)
12Chirurgische Klinik I, Universitätsklinikum Würzburg
Schlußfolgerung
Rezidive nach Altemeier Resektion sind …
weniger durch Patienten-Faktoren beeinflusst,
(Alter, Geschlecht, Komorbiditäten, Pathologika des
kleines Beckens)
sondern möglicherweise durch Operationstechniken
beeinflussbar
(Ausmaß der Resektion, Anwendung eines
Klammernahtgeräts)
Thank you for your attention
M. Kim, J. Reibetanz, N. Schlegel, C.-T. Germer, C. Isbert
Department of General, Gastrointestinal, Vascular and Paediatric SurgeryUniversity Hospital Würzburg
