Laparoscopic resection "recto"pexy with natural orifice specimen extraction for recurrent full-thickness rectal prolapse following Altemeier's procedure

Full-thickness external rectal prolapse recurrence after an Altemeier's procedure presents a complex surgical challenge. Redo perineal surgery risks further sphincter damage, while abdominal approaches like ventral mesh rectopexy carry mesh-related risks in extraperitonealised colons. Resection rectopexy is a viable alternative but requires careful navigation of the altered pelvic anatomy. We present a technical note and surgical video demonstrating laparoscopic resection rectopexy combined with transanal Natural Orifice Specimen Extraction (NOSE) and a single-stapled anastomosis for a recurrent prolapse 2 months post-Altemeier's. Essential technical considerations include meticulous close colonic dissection to preserve the inferior mesenteric artery and transanal extraction facilitated by a lax sphincter complex. The procedure was successfully completed with minimal blood loss (40 ml). The patient experienced an uneventful recovery, tolerating a normal diet by postoperative day 2, and was discharged on day 4. At the 6-month follow-up, there was no prolapse recurrence and faecal continence was maintained; mild stool frequency was effectively managed with low-dose anti-diarrhoeal medication. Laparoscopic resection rectopexy integrating transanal NOSE and a single-stapled anastomosis is a feasible, safe, and fully minimally invasive option. For selected, medically fit patients, it addresses the anatomical defects of recurrent prolapse following perineal procedures while minimising morbidity and anastomotic leak risks.