A stapler modification of the altemeier procedure for rectal prolapse. Experimental and clinical evaluation

The Altemeier procedure remains one of the better alternatives in elderly patients with rectal prolapse too fragile to undergo an abdominal operation. The circular stapler was studied first in a dog model then in humans to ascertain whether it added anything to the previously well-described technique. A fixed rectal prolapse was created in dogs by means of a laparotomy. This was later repaired by a transanal technique using a stapler modification of the Altemeier procedure. The same perineal approach was then applied to two elderly female patients with complete rectal prolapse. It was found to improve the quality and ease of a difficult anastomosis. The stapler device allowed a higher colonic resection and may have improved the postoperative continence occurring in 50 per cent of the patients with this problem. The stapler anastomosis narrowed rapidly causing better retention of stool in the first several months after surgery. The two patients repaired in this manner have had no recurrences and are continent of solid stool 3 years after surgery.